|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.60
|
| Rate for Payer: EPIC Health Plan Senior |
$823.60
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,214.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$2,309.05 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.11
|
| Rate for Payer: Blue Shield of California Commercial |
$377.23
|
| Rate for Payer: Blue Shield of California EPN |
$237.41
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Riverside University Health System MISP |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Riverside University Health System MISP |
$568.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC OCC THER APP OF SURFACE NEUROSTIMULATOR
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901307015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$98.01 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| 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 |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC OCC THER APP OF SURFACE NEUROSTIMULATOR
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901307015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC OCC THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905104525
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC OCC THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905104525
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| 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 |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.68 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$87.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Riverside University Health System MISP |
$85.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| 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 |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$175.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$273.28
|
| Rate for Payer: Cigna of CA PPO |
$315.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$298.90
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.38
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$4.64
|
| Rate for Payer: Riverside University Health System MISP |
$4.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.55
|
| Rate for Payer: United Healthcare HMO Rider |
$3.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.38
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$4.64
|
| Rate for Payer: Riverside University Health System MISP |
$4.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$5.92
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.32
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.64
|
| Rate for Payer: Prime Health Services Medicare |
$5.64
|
| Rate for Payer: Riverside University Health System MISP |
$5.85
|
| Rate for Payer: Riverside University Health System MISP |
$5.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$32.14 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.14
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.32
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.64
|
| Rate for Payer: Prime Health Services Medicare |
$5.64
|
| Rate for Payer: Riverside University Health System MISP |
$5.85
|
| Rate for Payer: Riverside University Health System MISP |
$5.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCUP THERAPY EVAL - 30 MIN
|
Facility
|
OP
|
$301.00
|
|
| Hospital Charge Code |
905104020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$109.26 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$123.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.70
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Riverside University Health System MISP |
$120.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| 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 |
$255.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC OCCUP THERAPY EVAL - 30 MIN
|
Facility
|
IP
|
$301.00
|
|
| Hospital Charge Code |
905104020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC OCCUP THERAPY EVAL - 45 MIN
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
905104001
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
|
HC OCCUP THERAPY EVAL - 45 MIN
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
905104001
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$156.09 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$318.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| 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 |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
