|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
IP
|
$4,798.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$959.60 |
| Max. Negotiated Rate |
$4,318.20 |
| Rate for Payer: Adventist Health Commercial |
$959.60
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,919.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,919.20
|
| Rate for Payer: Galaxy Health WC |
$4,078.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,878.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,318.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,200.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,828.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,969.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.60
|
| Rate for Payer: Multiplan Commercial |
$3,598.50
|
| Rate for Payer: Networks By Design Commercial |
$3,118.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,078.30
|
|
|
HC DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$6,378.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
904000013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.01 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,896.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,544.82
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,102.40
|
| Rate for Payer: Cigna of CA HMO |
$4,081.92
|
| Rate for Payer: Cigna of CA PPO |
$4,719.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,740.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,254.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,189.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$6,378.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
904000013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,275.60 |
| Max. Negotiated Rate |
$5,740.20 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,551.20
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,740.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,254.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,430.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,947.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.60
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: Cigna of CA HMO |
$252.16
|
| Rate for Payer: Cigna of CA PPO |
$291.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$197.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.80
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
| Rate for Payer: Riverside University Health System MISP |
$157.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.90
|
| Rate for Payer: Vantage Medical Group Senior |
$334.90
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905104360
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905601806
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905103360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: InnovAge PACE Commercial |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Riverside University Health System MISP |
$70.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| 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 |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905104360
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: InnovAge PACE Commercial |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Riverside University Health System MISP |
$70.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| 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 |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905103360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905601806
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: InnovAge PACE Commercial |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Riverside University Health System MISP |
$70.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| 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 |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: InnovAge PACE Commercial |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Riverside University Health System MISP |
$70.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| 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 |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: InnovAge PACE Commercial |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Riverside University Health System MISP |
$70.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| 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 |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT OT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905104362
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT OT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905104362
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| 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 |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
