|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
905353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$511.47 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.10
|
| Rate for Payer: Blue Shield of California Commercial |
$335.16
|
| Rate for Payer: Blue Shield of California Commercial |
$93.24
|
| Rate for Payer: Blue Shield of California EPN |
$211.20
|
| Rate for Payer: Blue Shield of California EPN |
$58.76
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Central Health Plan Commercial |
$425.60
|
| Rate for Payer: Cigna of CA HMO |
$340.48
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$393.68
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$337.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Central Health Plan Commercial |
$425.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.80
|
| Rate for Payer: EPIC Health Plan Senior |
$212.80
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$337.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$313.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$511.47 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.10
|
| Rate for Payer: Blue Shield of California Commercial |
$90.72
|
| Rate for Payer: Blue Shield of California EPN |
$57.17
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Blue Shield of California Commercial |
$399.42
|
| Rate for Payer: Blue Shield of California Commercial |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$251.70
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Blue Shield of California Commercial |
$68.67
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC SPECIMEN HANDLING
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC SPECIMEN HANDLING
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$99.21 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.21
|
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.54
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Riverside University Health System MISP |
$34.80
|
| Rate for Payer: Riverside University Health System MISP |
$12.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$27.20
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,920.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,097.60
|
| Rate for Payer: Galaxy Health WC |
$2,332.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,646.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,469.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,742.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,618.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$2,058.00
|
| Rate for Payer: Networks By Design Commercial |
$1,783.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$163.73 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$738.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,728.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.37
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Cigna of CA HMO |
$1,756.16
|
| Rate for Payer: Cigna of CA PPO |
$2,030.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,920.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$2,332.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,646.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,469.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,742.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$2,058.00
|
| Rate for Payer: Networks By Design Commercial |
$1,783.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.87
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
| Rate for Payer: Prime Health Services Medicare |
$183.24
|
| Rate for Payer: Riverside University Health System MISP |
$190.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,646.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,920.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,097.60
|
| Rate for Payer: Galaxy Health WC |
$2,332.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,646.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,469.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,742.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,618.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$2,058.00
|
| Rate for Payer: Networks By Design Commercial |
$1,783.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$163.73 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$738.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,728.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.37
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Cigna of CA HMO |
$1,756.16
|
| Rate for Payer: Cigna of CA PPO |
$2,030.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,920.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$2,332.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,646.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,469.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,742.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$2,058.00
|
| Rate for Payer: Networks By Design Commercial |
$1,783.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.87
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
| Rate for Payer: Prime Health Services Medicare |
$183.24
|
| Rate for Payer: Riverside University Health System MISP |
$190.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,646.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
|
OP
|
$5,151.00
|
|
|
Service Code
|
CPT 77321 TC
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$140.54 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$379.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,378.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,833.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,863.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$957.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3,245.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.95
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.80
|
| Rate for Payer: Cigna of CA HMO |
$3,296.64
|
| Rate for Payer: Cigna of CA PPO |
$3,811.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,378.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,378.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,378.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.40
|
| Rate for Payer: Galaxy Health WC |
$4,378.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,039.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,605.70
|
| Rate for Payer: Multiplan Commercial |
$3,863.25
|
| Rate for Payer: Networks By Design Commercial |
$3,348.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,378.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,060.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,378.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,378.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,378.35
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
|
IP
|
$5,151.00
|
|
|
Service Code
|
CPT 77321 TC
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,030.20 |
| Max. Negotiated Rate |
$4,635.90 |
| Rate for Payer: Adventist Health Commercial |
$1,030.20
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.40
|
| Rate for Payer: Galaxy Health WC |
$4,378.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,039.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.20
|
| Rate for Payer: Multiplan Commercial |
$3,863.25
|
| Rate for Payer: Networks By Design Commercial |
$3,348.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,378.35
|
|
|
HC SPEECH EVALUATION MCAL
|
Facility
|
OP
|
$1,426.00
|
|
| Hospital Charge Code |
905601210
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Adventist Health Commercial |
$584.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$866.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,212.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$784.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,069.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,140.80
|
| Rate for Payer: Cigna of CA HMO |
$912.64
|
| Rate for Payer: Cigna of CA PPO |
$1,055.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,212.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,212.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,212.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$998.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.40
|
| Rate for Payer: EPIC Health Plan Senior |
$570.40
|
| Rate for Payer: Galaxy Health WC |
$1,212.10
|
| Rate for Payer: Global Benefits Group Commercial |
$855.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,283.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$905.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$841.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$998.20
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: Networks By Design Commercial |
$926.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.10
|
| Rate for Payer: Riverside University Health System MISP |
$570.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$855.60
|
| 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 |
$1,212.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,212.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,212.10
|
|
|
HC SPEECH EVALUATION MCAL
|
Facility
|
IP
|
$1,426.00
|
|
| Hospital Charge Code |
905601210
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$285.20 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Adventist Health Commercial |
$285.20
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,140.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$998.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.40
|
| Rate for Payer: EPIC Health Plan Senior |
$570.40
|
| Rate for Payer: Galaxy Health WC |
$1,212.10
|
| Rate for Payer: Global Benefits Group Commercial |
$855.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,283.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$905.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$841.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.20
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: Networks By Design Commercial |
$926.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.10
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018139
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018239
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018439
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018139
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018239
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SPEECH LANG CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018439
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
