|
HC MICROHEMATOCRIT SPUN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.65
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,690.50 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.58
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,525.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,525.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,392.97
|
| 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 |
$1,127.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,099.95
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.10
|
| 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 |
$1,329.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,075.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,577.80
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,127.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 MOBILITY CURRENT STATU
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8978
|
| Hospital Charge Code |
900018400
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOBILITY CURRENT STATU
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8978
|
| Hospital Charge Code |
900018400
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOBILITY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8978
|
| Hospital Charge Code |
900018300
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan 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 |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
900018402
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan 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: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOBILITY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8980
|
| Hospital Charge Code |
900018402
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
900018401
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/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 |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8979
|
| Hospital Charge Code |
900018401
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.72
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.72
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$98.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.31
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.90
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Senior |
$23.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
|
|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| 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 |
$17.01
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Blue Shield of California EPN |
$16.59
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| 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 |
$20.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
