|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| 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 |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,556.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,551.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.14
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$301.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.87
|
| Rate for Payer: Blue Shield of California Commercial |
$280.91
|
| Rate for Payer: Blue Shield of California EPN |
$185.44
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA HMO |
$293.76
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$321.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.30
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| 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 |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| 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 |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| 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 |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| 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 |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
OP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
905357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,710.24 |
| Max. Negotiated Rate |
$6,057.10 |
| Rate for Payer: Adventist Health Commercial |
$2,921.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,919.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,127.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,463.24
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,057.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,057.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,988.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,988.20
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,057.10
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
IP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
905357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,425.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
IP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
915357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,425.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
OP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
915357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,710.24 |
| Max. Negotiated Rate |
$6,057.10 |
| Rate for Payer: Adventist Health Commercial |
$2,921.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,919.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,127.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,463.24
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,057.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,057.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,988.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,988.20
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,057.10
|
|
