|
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 Non-Gatekeeper |
$65.51
|
| 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 |
$347.00
|
| 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 |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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 Non-Gatekeeper |
$65.51
|
| 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 |
$347.00
|
| 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 |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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: Aetna of CA Non-Gatekeeper |
$68.26
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$113.34
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$108.77
|
| 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 |
$347.00
|
| 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 |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 Non-Gatekeeper |
$108.77
|
| 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 |
$347.00
|
| 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 |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$113.34
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$846.66
|
| 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 |
$347.00
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$653.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$882.28
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.49
|
| Rate for Payer: Heritage Provider Network Senior |
$927.49
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$388.72
|
| 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 |
$347.00
|
| 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 |
$283.05
|
| Rate for Payer: Cash Price |
$283.05
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$300.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$405.08
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.83
|
| Rate for Payer: Heritage Provider Network Senior |
$425.83
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$388.72
|
| 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 |
$347.00
|
| 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 |
$283.05
|
| Rate for Payer: Cash Price |
$283.05
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$300.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$405.08
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.83
|
| Rate for Payer: Heritage Provider Network Senior |
$425.83
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$882.28
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.49
|
| Rate for Payer: Heritage Provider Network Senior |
$927.49
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$846.66
|
| 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 |
$347.00
|
| 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 |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$653.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Non-Gatekeeper |
$231.75
|
| 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 |
$347.00
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.75
|
| 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 |
$347.00
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.75
|
| 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 |
$347.00
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| 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 |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.75
|
| 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 |
$347.00
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| 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 |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.50
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
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 Non-Gatekeeper |
$231.75
|
| 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 |
$347.00
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
