|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
IP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
915356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,046.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,876.50
|
| Rate for Payer: Cash Price |
$2,876.50
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,488.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,237.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.20
|
| Rate for Payer: Multiplan Commercial |
$4,184.00
|
| Rate for Payer: Networks By Design Commercial |
$2,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
OP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
905356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,255.20 |
| Max. Negotiated Rate |
$4,445.50 |
| Rate for Payer: Adventist Health Commercial |
$2,144.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,876.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,922.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,029.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,859.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,541.78
|
| Rate for Payer: Cash Price |
$2,876.50
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,445.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,445.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,488.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,237.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,661.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,661.00
|
| Rate for Payer: Multiplan Commercial |
$4,184.00
|
| Rate for Payer: Networks By Design Commercial |
$2,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,445.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,445.50
|
|
|
HC MICROPRO CNTRL FEATURE ADDN UE
|
Facility
|
IP
|
$5,230.00
|
|
|
Service Code
|
CPT L6882
|
| Hospital Charge Code |
905356882
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,046.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,876.50
|
| Rate for Payer: Cash Price |
$2,876.50
|
| Rate for Payer: Cigna of CA HMO |
$3,661.00
|
| Rate for Payer: Cigna of CA PPO |
$3,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,092.00
|
| Rate for Payer: Galaxy Health WC |
$4,445.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,488.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,237.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.20
|
| Rate for Payer: Multiplan Commercial |
$4,184.00
|
| Rate for Payer: Networks By Design Commercial |
$2,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,445.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,910.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,869.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,712.83
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,478.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,239.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,690.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,384.18
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: Cigna of CA HMO |
$1,442.56
|
| Rate for Payer: Cigna of CA PPO |
$1,667.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,915.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,915.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.60
|
| Rate for Payer: EPIC Health Plan Senior |
$901.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,503.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,395.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,577.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,577.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.20
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,352.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,352.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,127.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,127.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,915.90
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.60
|
| Rate for Payer: EPIC Health Plan Senior |
$901.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,503.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,395.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$1,803.20
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
|
|
HC MISC CD FLOW MARKER (EA)
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$278.97
|
| Rate for Payer: Blue Shield of California EPN |
$184.31
|
| Rate for Payer: Cash Price |
$229.35
|
| Rate for Payer: Cash Price |
$229.35
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC MISC CD FLOW MARKER (EA)
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$354.45 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Cash Price |
$229.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.08
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC MISC CYTOPLAMIC FLOW MARKER EA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$165.91
|
| Rate for Payer: Blue Shield of California EPN |
$109.62
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.80
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC MISC CYTOPLAMIC FLOW MARKER EA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC MITRACLIP SYSTEM
|
Facility
|
OP
|
$45,000.00
|
|
| Hospital Charge Code |
906812554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,000.00 |
| Max. Negotiated Rate |
$38,250.00 |
| Rate for Payer: Adventist Health Commercial |
$9,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,064.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33,210.00
|
| Rate for Payer: Blue Shield of California EPN |
$21,870.00
|
| Rate for Payer: Cash Price |
$24,750.00
|
| Rate for Payer: Cigna of CA HMO |
$31,500.00
|
| Rate for Payer: Cigna of CA PPO |
$31,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$38,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18,000.00
|
| Rate for Payer: Galaxy Health WC |
$38,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$27,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,015.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,145.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,855.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,500.00
|
| Rate for Payer: Multiplan Commercial |
$36,000.00
|
| Rate for Payer: Networks By Design Commercial |
$22,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$38,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,888.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$16,083.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$38,250.00
|
|
|
HC MITRACLIP SYSTEM
|
Facility
|
IP
|
$45,000.00
|
|
| Hospital Charge Code |
906812554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,000.00 |
| Max. Negotiated Rate |
$38,250.00 |
| Rate for Payer: Adventist Health Commercial |
$9,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$24,750.00
|
| Rate for Payer: Cash Price |
$24,750.00
|
| Rate for Payer: Cigna of CA HMO |
$31,500.00
|
| Rate for Payer: Cigna of CA PPO |
$31,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18,000.00
|
| Rate for Payer: Galaxy Health WC |
$38,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$27,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,015.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,145.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,855.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,800.00
|
| Rate for Payer: Multiplan Commercial |
$36,000.00
|
| Rate for Payer: Networks By Design Commercial |
$22,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$38,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,888.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$16,083.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,737.50
|
|
|
HC MNT RA SUB 2ND RFRL GROUP EA 30 MIN
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
902000271
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC MNT RA SUB 2ND RFRL GROUP EA 30 MIN
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
902000271
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC MNT RA SUB 2ND RFRL INDIV W PT EA 15 MIN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
902000270
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.58
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC MNT RA SUB 2ND RFRL INDIV W PT EA 15 MIN
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
902000270
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
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: 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 MOBILITY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8978
|
| Hospital Charge Code |
900018300
|
|
Hospital Revenue Code
|
440
|
| 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 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: 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 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: 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 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: 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 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: 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 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 |
$75.35
|
| 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 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: 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 |
$75.35
|
| Rate for Payer: Cash Price |
$75.35
|
| 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: Networks By Design Commercial |
$89.05
|
| 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 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 |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| 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 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 |
$71.50
|
| 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
|
|
