|
HC MOBILITY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8978
|
| Hospital Charge Code |
900018300
|
|
Hospital Revenue Code
|
440
|
| 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: 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 MOBILITY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8980
|
| Hospital Charge Code |
900018302
|
|
Hospital Revenue Code
|
440
|
| 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: 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 MOBILITY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8980
|
| Hospital Charge Code |
900018302
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8979
|
| Hospital Charge Code |
900018301
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8979
|
| Hospital Charge Code |
900018301
|
|
Hospital Revenue Code
|
440
|
| 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: 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 MODIFICATION DIABETIC SHOE PER SHOE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5507
|
| Hospital Charge Code |
915655507
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.13
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MODIFICATION DIABETIC SHOE PER SHOE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5507
|
| Hospital Charge Code |
915655507
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MODIFICATION UNSPECIFIED PER SHOE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT L3649
|
| Hospital Charge Code |
915653649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.30
|
| Rate for Payer: Blue Shield of California Commercial |
$95.94
|
| Rate for Payer: Blue Shield of California EPN |
$63.18
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC MODIFICATION UNSPECIFIED PER SHOE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT L3649
|
| Hospital Charge Code |
915653649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| 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 |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$143.36
|
| Rate for Payer: Cigna of CA PPO |
$165.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| 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 |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.88
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$827.90 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.14
|
| Rate for Payer: Blue Shield of California Commercial |
$718.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.36
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$827.90 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.14
|
| Rate for Payer: Blue Shield of California Commercial |
$718.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.36
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$717.40 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.84
|
| Rate for Payer: Blue Shield of California Commercial |
$622.87
|
| Rate for Payer: Blue Shield of California EPN |
$410.18
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$717.40 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.84
|
| Rate for Payer: Blue Shield of California Commercial |
$622.87
|
| Rate for Payer: Blue Shield of California EPN |
$410.18
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
OP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$257.91
|
| Rate for Payer: Blue Shield of California EPN |
$170.40
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Cigna of CA HMO |
$246.73
|
| Rate for Payer: Cigna of CA PPO |
$285.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$308.41
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$327.68 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Multiplan Commercial |
$308.41
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
