|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
OP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.77
|
| Rate for Payer: Blue Shield of California Commercial |
$325.90
|
| Rate for Payer: Blue Shield of California EPN |
$214.62
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$309.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: EPIC Health Plan Senior |
$176.64
|
| Rate for Payer: Galaxy Health WC |
$375.36
|
| Rate for Payer: Global Benefits Group Commercial |
$264.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$353.28
|
| Rate for Payer: Networks By Design Commercial |
$220.80
|
| Rate for Payer: Prime Health Services Commercial |
$375.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.73
|
| Rate for Payer: United Healthcare All Other HMO |
$161.32
|
| Rate for Payer: United Healthcare HMO Rider |
$157.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$309.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: EPIC Health Plan Senior |
$176.64
|
| Rate for Payer: Galaxy Health WC |
$375.36
|
| Rate for Payer: Global Benefits Group Commercial |
$264.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.98
|
| Rate for Payer: Multiplan Commercial |
$353.28
|
| Rate for Payer: Networks By Design Commercial |
$220.80
|
| Rate for Payer: Prime Health Services Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.73
|
| Rate for Payer: United Healthcare All Other HMO |
$161.32
|
| Rate for Payer: United Healthcare HMO Rider |
$157.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.62
|
|
|
HC MED ENTEER GUIDEWIRE
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Adventist Health Commercial |
$267.80
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.36
|
| Rate for Payer: Multiplan Commercial |
$1,071.20
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
|
|
HC MED ENTEER GUIDEWIRE
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Adventist Health Commercial |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$878.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.28
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cigna of CA HMO |
$856.96
|
| Rate for Payer: Cigna of CA PPO |
$990.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,138.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,138.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$937.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$937.30
|
| Rate for Payer: Multiplan Commercial |
$1,071.20
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,138.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,138.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.15
|
|
|
HC MED ENTEER RE ENTRY CATH
|
Facility
|
IP
|
$6,051.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.20 |
| Max. Negotiated Rate |
$5,143.35 |
| Rate for Payer: Adventist Health Commercial |
$1,210.20
|
| Rate for Payer: Cash Price |
$3,328.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.40
|
| Rate for Payer: Galaxy Health WC |
$5,143.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,745.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.24
|
| Rate for Payer: Multiplan Commercial |
$4,840.80
|
| Rate for Payer: Networks By Design Commercial |
$3,933.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,143.35
|
|
|
HC MED ENTEER RE ENTRY CATH
|
Facility
|
OP
|
$6,051.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.20 |
| Max. Negotiated Rate |
$5,143.35 |
| Rate for Payer: Adventist Health Commercial |
$1,210.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,968.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,328.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,538.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,715.92
|
| Rate for Payer: Cash Price |
$3,328.05
|
| Rate for Payer: Cigna of CA HMO |
$3,872.64
|
| Rate for Payer: Cigna of CA PPO |
$4,477.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,143.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,143.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.40
|
| Rate for Payer: Galaxy Health WC |
$5,143.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,745.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.70
|
| Rate for Payer: Multiplan Commercial |
$4,840.80
|
| Rate for Payer: Networks By Design Commercial |
$3,933.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,143.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,025.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,025.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,025.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,143.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,143.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,143.35
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC MEDI BTLER-DONNG DEVC COMP SLV
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC MEDI DONNG GLV COMPRSN GARMENT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC MEDI DONNG GLV COMPRSN GARMENT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC MEDI DONNG GLV COMPRSN GARMENT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC MEDI DONNG GLV COMPRSN GARMENT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC MED RELIANT BALLOON CATH
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,739.95 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
|
|
HC MED RELIANT BALLOON CATH
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,739.95 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,342.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,257.06
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Cigna of CA HMO |
$1,310.08
|
| Rate for Payer: Cigna of CA PPO |
$1,514.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018135
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018135
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
