|
HC OBSTETRIC PANEL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$119.80 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.31
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.54
|
| Rate for Payer: EPIC Health Plan Senior |
$47.81
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.81
|
| Rate for Payer: InnovAge PACE Commercial |
$71.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.07
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$50.68
|
| Rate for Payer: Riverside University Health System MISP |
$52.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.73
|
| Rate for Payer: United Healthcare All Other HMO |
$38.73
|
| Rate for Payer: United Healthcare HMO Rider |
$38.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Vantage Medical Group Senior |
$47.81
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
IP
|
$20.75
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Central Health Plan Commercial |
$16.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.64
|
| Rate for Payer: Global Benefits Group Commercial |
$12.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
| Rate for Payer: Networks By Design Commercial |
$13.49
|
| Rate for Payer: Prime Health Services Commercial |
$17.64
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
OP
|
$20.75
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.19
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Central Health Plan Commercial |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$13.28
|
| Rate for Payer: Cigna of CA PPO |
$15.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.64
|
| Rate for Payer: Global Benefits Group Commercial |
$12.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.68
|
| Rate for Payer: InnovAge PACE Commercial |
$10.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
| Rate for Payer: Networks By Design Commercial |
$13.49
|
| Rate for Payer: Prime Health Services Commercial |
$17.64
|
| Rate for Payer: Riverside University Health System MISP |
$8.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.38
|
| Rate for Payer: United Healthcare All Other HMO |
$10.38
|
| Rate for Payer: United Healthcare HMO Rider |
$10.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.64
|
| Rate for Payer: Vantage Medical Group Senior |
$17.64
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
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 |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,274.52
|
| 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 OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.16 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,250.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,132.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,544.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,209.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,249.81
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,750.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,750.15
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$89.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,029.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,274.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,441.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,441.30
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$823.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,750.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,750.15
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,250.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,209.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,249.81
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$177.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,274.52
|
| 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 |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.34
|
| 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 |
$349.44
|
| Rate for Payer: Blue Shield of California Commercial |
$363.55
|
| Rate for Payer: Blue Shield of California EPN |
$237.41
|
| Rate for Payer: Cash Price |
$327.25
|
| 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: 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: InnovAge PACE Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$368.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
$327.25
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| 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 Permanente of CA Commercial/Self Funded |
$396.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$368.31
|
| 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 |
$687.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| 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: 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: InnovAge PACE Commercial |
$710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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
|
$1,235.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,111.50 |
| Rate for Payer: Adventist Health Commercial |
$247.00
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Central Health Plan Commercial |
$988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$494.00
|
| Rate for Payer: Galaxy Health WC |
$1,049.75
|
| Rate for Payer: Global Benefits Group Commercial |
$741.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,111.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$764.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$926.25
|
| Rate for Payer: Networks By Design Commercial |
$802.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,049.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$247.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,049.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$679.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$926.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$597.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$725.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Central Health Plan Commercial |
$988.00
|
| Rate for Payer: Cigna of CA HMO |
$790.40
|
| Rate for Payer: Cigna of CA PPO |
$913.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,049.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,049.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,049.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$494.00
|
| Rate for Payer: Galaxy Health WC |
$1,049.75
|
| Rate for Payer: Global Benefits Group Commercial |
$741.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,111.50
|
| Rate for Payer: InnovAge PACE Commercial |
$617.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$764.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$864.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$864.50
|
| Rate for Payer: Multiplan Commercial |
$926.25
|
| Rate for Payer: Networks By Design Commercial |
$802.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,049.75
|
| Rate for Payer: Riverside University Health System MISP |
$494.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$741.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$1,049.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,049.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,049.75
|
|
|
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 |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| 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 Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| 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 |
$102.87 |
| Max. Negotiated Rate |
$447.00 |
| 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 |
$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 |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| 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: 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: InnovAge PACE Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| 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 Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| 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 |
$91.30
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| 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 Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| 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 |
$63.25 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| 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 |
$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 |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| 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: 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: InnovAge PACE Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$117.70
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| 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 Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| 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 15MIN
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.53 |
| Max. Negotiated Rate |
$447.00 |
| 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 |
$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 |
$117.70
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Cash Price |
$117.70
|
| 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: 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: InnovAge PACE Commercial |
$107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.80
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$234.85
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| 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 Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| 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 OCC THER EVALUATION INITIAL 30MIN
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$447.00 |
| 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 |
$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 |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| 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: 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: InnovAge PACE Commercial |
$213.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.90
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$121.46
|
| 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 |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| 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: EPIC Health Plan Commercial |
$5.91
|
| Rate for Payer: EPIC Health Plan Senior |
$4.38
|
| 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: InnovAge PACE Commercial |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.87
|
| Rate for Payer: Molina Healthcare of CA 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
|
300
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| 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 Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| 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
|
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 |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| 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 Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| 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
|
|
