|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
905353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Blue Shield of California EPN |
$90.78
|
| 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: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| 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
|
|
|
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 |
$59.50 |
| Max. Negotiated Rate |
$338.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$338.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.44
|
| Rate for Payer: BCBS Transplant Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$92.48
|
| 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: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$127.50
|
| Rate for Payer: IEHP medi-cal |
$59.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| 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 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 |
$85.00
|
| Rate for Payer: United Healthcare All Other HMO |
$85.00
|
| Rate for Payer: United Healthcare HMO Rider |
$85.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.00
|
| 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
IP
|
$544.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Central Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$489.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$451.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.41
|
| Rate for Payer: BCBS Transplant Transplant |
$90.60
|
| Rate for Payer: Blue Shield of California Commercial |
$93.32
|
| Rate for Payer: Blue Shield of California EPN |
$73.39
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$113.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: IEHP medi-cal |
$111.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Innovage PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: Riverside University Health MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| 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 |
$4,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$451.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.41
|
| Rate for Payer: BCBS Transplant Transplant |
$88.80
|
| Rate for Payer: Blue Shield of California Commercial |
$91.46
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| 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: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: IEHP medi-cal |
$111.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Innovage PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: Riverside University Health MISP |
$74.47
|
| 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 |
$4,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: BCBS Transplant Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.23
|
| Rate for Payer: Blue Shield of California EPN |
$70.96
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$109.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| 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 |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
IP
|
$95.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.00
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: BCBS Transplant Transplant |
$57.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.71
|
| Rate for Payer: Blue Shield of California EPN |
$46.17
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| 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 HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SPECIMEN HANDLING
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC SPECIMEN HANDLING
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$87.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.04
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: IEHP medi-cal |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| 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 Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
OP
|
$2,075.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$169.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$651.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$803.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,282.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.45
|
| Rate for Payer: Caremore Medicare Advantage |
$169.53
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: Cigna of CA HMO |
$1,328.00
|
| Rate for Payer: Cigna of CA PPO |
$1,535.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,556.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$278.03
|
| Rate for Payer: IEHP medi-cal |
$279.72
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Innovage PACE Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,348.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: Prime Health Services Medicare |
$179.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: Riverside University Health MISP |
$186.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
IP
|
$2,075.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,348.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
IP
|
$2,075.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,348.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
OP
|
$2,075.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$169.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$651.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$803.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,282.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.45
|
| Rate for Payer: Caremore Medicare Advantage |
$169.53
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: Cigna of CA HMO |
$1,328.00
|
| Rate for Payer: Cigna of CA PPO |
$1,535.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,556.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$278.03
|
| Rate for Payer: IEHP medi-cal |
$279.72
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Innovage PACE Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,348.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: Prime Health Services Medicare |
$179.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: Riverside University Health MISP |
$186.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
OP
|
$4,479.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$335.25 |
| Max. Negotiated Rate |
$4,031.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$957.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,167.68
|
| Rate for Payer: BCBS Transplant Transplant |
$2,687.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,768.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,176.79
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$2,015.55
|
| Rate for Payer: Cash Price |
$2,015.55
|
| Rate for Payer: Cash Price |
$2,015.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,583.20
|
| Rate for Payer: Cigna of CA HMO |
$2,866.56
|
| Rate for Payer: Cigna of CA PPO |
$3,314.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,807.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,687.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,031.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,359.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,987.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,359.25
|
| Rate for Payer: Networks By Design Commercial |
$2,911.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,807.15
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,687.40
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,687.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
IP
|
$4,479.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$895.80 |
| Max. Negotiated Rate |
$4,031.10 |
| Rate for Payer: Cash Price |
$2,015.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,583.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,791.60
|
| Rate for Payer: Galaxy Health WC |
$3,807.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,687.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,031.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,987.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.80
|
| Rate for Payer: Multiplan Commercial |
$3,359.25
|
| Rate for Payer: Networks By Design Commercial |
$2,911.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,807.15
|
|
|
HC SPEECH EVALUATION MCAL
|
Facility
IP
|
$1,345.00
|
|
| Hospital Charge Code |
905601210
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$1,210.50 |
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
| Rate for Payer: Networks By Design Commercial |
$874.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
|
|
HC SPEECH EVALUATION MCAL
|
Facility
OP
|
$1,345.00
|
|
| Hospital Charge Code |
905601210
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,210.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$816.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$739.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$739.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$807.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.00
|
| Rate for Payer: Cigna of CA HMO |
$860.80
|
| Rate for Payer: Cigna of CA PPO |
$995.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,008.75
|
| Rate for Payer: IEHP medi-cal |
$470.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.45
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
| Rate for Payer: Networks By Design Commercial |
$874.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$807.00
|
| Rate for Payer: Riverside University Health MISP |
$538.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.25
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
OP
|
$860.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000460
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$405.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$731.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$473.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$473.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$516.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Central Health Plan Commercial |
$688.00
|
| Rate for Payer: Cigna of CA HMO |
$550.40
|
| Rate for Payer: Cigna of CA PPO |
$636.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$731.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$344.00
|
| Rate for Payer: Galaxy Health WC |
$731.00
|
| Rate for Payer: Global Benefits Group Commercial |
$516.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$645.00
|
| Rate for Payer: IEHP medi-cal |
$301.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.60
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$731.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$516.00
|
| Rate for Payer: Riverside University Health MISP |
$344.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$731.00
|
| Rate for Payer: Vantage Medical Group Senior |
$731.00
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
IP
|
$860.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000460
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$172.00 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Central Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.00
|
| Rate for Payer: Galaxy Health WC |
$731.00
|
| Rate for Payer: Global Benefits Group Commercial |
$516.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.00
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$731.00
|
|
|
HC SPEECH & LANG TRT
|
Facility
OP
|
$687.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905600430
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$618.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$405.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$583.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$377.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$377.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$412.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Central Health Plan Commercial |
$549.60
|
| Rate for Payer: Cigna of CA HMO |
$439.68
|
| Rate for Payer: Cigna of CA PPO |
$508.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$583.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.80
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$618.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$515.25
|
| Rate for Payer: IEHP medi-cal |
$240.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$458.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.67
|
| Rate for Payer: Multiplan Commercial |
$515.25
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$412.20
|
| Rate for Payer: Riverside University Health MISP |
$274.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$412.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$412.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$583.95
|
| Rate for Payer: Vantage Medical Group Senior |
$583.95
|
|
|
HC SPEECH & LANG TRT
|
Facility
IP
|
$687.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905600430
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$618.30 |
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Central Health Plan Commercial |
$549.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.80
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$618.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$458.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.40
|
| Rate for Payer: Multiplan Commercial |
$515.25
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
|
|
HC SPINAL LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
909000180
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$2,163.60 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,163.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
