|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.39
|
| Rate for Payer: Blue Shield of California Commercial |
$89.84
|
| Rate for Payer: Blue Shield of California EPN |
$58.76
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| 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 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 |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
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 |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| 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 Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| 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 |
$4.39 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.39
|
| Rate for Payer: Blue Shield of California Commercial |
$87.41
|
| Rate for Payer: Blue Shield of California EPN |
$57.17
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| 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 |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| 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 |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| 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 |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| 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 |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$101.98
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| 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 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
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 |
$4.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$66.16
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
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 |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| 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 Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| 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
|
$32.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
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 |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| 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 Medi-Cal |
$17.60
|
| 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 HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.42
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: InnovAge PACE Commercial |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Riverside University Health System MISP |
$12.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| 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 HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| 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 Senior |
$27.20
|
|
|
HC SPEC LEAD CLIPPERS
|
Facility
|
OP
|
$441.00
|
|
| Hospital Charge Code |
906812708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.00
|
| Rate for Payer: Blue Shield of California Commercial |
$269.45
|
| Rate for Payer: Blue Shield of California EPN |
$175.96
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: InnovAge PACE Commercial |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Riverside University Health System MISP |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$220.50
|
| Rate for Payer: United Healthcare HMO Rider |
$220.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
|
HC SPEC LEAD CLIPPERS
|
Facility
|
IP
|
$441.00
|
|
| Hospital Charge Code |
906812708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC SPEC LEAD CUTTER
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.57
|
| Rate for Payer: Blue Shield of California Commercial |
$318.94
|
| Rate for Payer: Blue Shield of California EPN |
$208.28
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: InnovAge PACE Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC SPEC LEAD CUTTER
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
|
HC SPEC LLD ACCESSORY KIT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SPEC LLD ACCESSORY KIT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC 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 |
$1,509.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,830.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,045.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,698.54
|
| 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 |
$133.70 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$168.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,666.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.37
|
| Rate for Payer: Cash Price |
$1,509.20
|
| Rate for Payer: Cash Price |
$1,509.20
|
| Rate for Payer: Cash Price |
$1,509.20
|
| 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 |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| 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 |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: InnovAge PACE Commercial |
$253.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,830.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| 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 |
$168.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
| Rate for Payer: Prime Health Services Medicare |
$178.82
|
| Rate for Payer: Riverside University Health System MISP |
$185.57
|
| 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 |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
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 |
$1,509.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,195.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,830.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,045.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,698.54
|
| 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 |
$133.70 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$168.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,666.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.37
|
| Rate for Payer: Cash Price |
$1,509.20
|
| Rate for Payer: Cash Price |
$1,509.20
|
| Rate for Payer: Cash Price |
$1,509.20
|
| 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 |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| 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 |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: InnovAge PACE Commercial |
$253.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,830.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| 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 |
$168.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,332.40
|
| Rate for Payer: Prime Health Services Medicare |
$178.82
|
| Rate for Payer: Riverside University Health System MISP |
$185.57
|
| 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 |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
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 |
$3,128.20
|
| 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 |
$194.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.95
|
| Rate for Payer: Cash Price |
$2,833.05
|
| Rate for Payer: Cash Price |
$2,833.05
|
| Rate for Payer: Cash Price |
$2,833.05
|
| 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: 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: InnovAge PACE Commercial |
$2,575.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,188.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,605.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$2,833.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$3,435.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,188.47
|
| 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
|
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 |
$784.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,140.80
|
| 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 Permanente of CA Commercial/Self Funded |
$951.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.69
|
| 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 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Cash Price |
$784.30
|
| 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: 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: InnovAge PACE Commercial |
$713.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$951.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$998.20
|
| Rate for Payer: Molina Healthcare of CA 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 LANG CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9174
|
| Hospital Charge Code |
900018439
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 |
900018439
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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
|
|
