|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$502.50 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$460.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$435.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$319.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$221.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DESTUCT BY NEURO AGENT
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,430.55
|
| Rate for Payer: Cash Price |
$1,430.55
|
| Rate for Payer: Cash Price |
$1,430.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,610.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC DESTUCT BY NEURO AGENT
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.78 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Cash Price |
$1,430.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$156.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Senior |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$139.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905601806
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Senior |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905601806
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905103360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905104360
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905104360
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Senior |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905103360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$94.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Senior |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.94
|
| Rate for Payer: Heritage Provider Network Senior |
$108.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$94.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Senior |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.94
|
| Rate for Payer: Heritage Provider Network Senior |
$108.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$72.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$94.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Senior |
$149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.94
|
| Rate for Payer: Heritage Provider Network Senior |
$108.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,164.50 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$732.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$890.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Senior |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$848.03
|
| Rate for Payer: Heritage Provider Network Senior |
$848.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$653.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$247.97 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.49
|
| Rate for Payer: Heritage Provider Network Senior |
$927.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
|
|
HC DEVELOP TEST EXT W/RPT OT
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905104362
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$534.65 |
| Rate for Payer: Adventist Health Commercial |
$257.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$336.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$534.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$408.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$534.65
|
| Rate for Payer: Dignity Health Senior |
$534.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.35
|
| Rate for Payer: Heritage Provider Network Senior |
$389.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$300.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$440.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$440.30
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$534.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$534.65
|
| Rate for Payer: Vantage Medical Group Senior |
$534.65
|
|
|
HC DEVELOP TEST EXT W/RPT OT
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905104362
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$113.85 |
| Max. Negotiated Rate |
$471.75 |
| Rate for Payer: Adventist Health Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.83
|
| Rate for Payer: Heritage Provider Network Senior |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$534.65 |
| Rate for Payer: Adventist Health Commercial |
$257.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$336.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$534.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$408.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$534.65
|
| Rate for Payer: Dignity Health Senior |
$534.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.35
|
| Rate for Payer: Heritage Provider Network Senior |
$389.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$300.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$440.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$440.30
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$534.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$534.65
|
| Rate for Payer: Vantage Medical Group Senior |
$534.65
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$113.85 |
| Max. Negotiated Rate |
$471.75 |
| Rate for Payer: Adventist Health Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.83
|
| Rate for Payer: Heritage Provider Network Senior |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$247.97 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.49
|
| Rate for Payer: Heritage Provider Network Senior |
$927.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$1,164.50 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$732.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$890.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Senior |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$848.03
|
| Rate for Payer: Heritage Provider Network Senior |
$848.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$653.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
