|
HC SHOE POST-OP MALE LARGE
|
Facility
|
OP
|
$38.13
|
|
| Hospital Charge Code |
901606729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.47
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC SHOE POST-OP MALE MEDIUM
|
Facility
|
OP
|
$38.13
|
|
| Hospital Charge Code |
901606728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.47
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC SHOE POST-OP MALE MEDIUM
|
Facility
|
IP
|
$38.13
|
|
| Hospital Charge Code |
901606728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
|
HC SHOE POST-OP MALE SMALL
|
Facility
|
OP
|
$38.13
|
|
| Hospital Charge Code |
901606727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.47
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC SHOE POST-OP MALE SMALL
|
Facility
|
IP
|
$38.13
|
|
| Hospital Charge Code |
901606727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
|
HC SHOES MENS DEPTH INLAY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3221
|
| Hospital Charge Code |
905353221
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC SHOES MENS DEPTH INLAY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3221
|
| Hospital Charge Code |
915353221
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SHOES MENS DEPTH INLAY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3221
|
| Hospital Charge Code |
905353221
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.54
|
| Rate for Payer: Blue Shield of California Commercial |
$339.90
|
| Rate for Payer: Blue Shield of California Commercial |
$224.09
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC SHOES MENS DEPTH INLAY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3221
|
| Hospital Charge Code |
915353221
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.05
|
| Rate for Payer: Blue Shield of California Commercial |
$115.35
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SHOES MENS HIGHTOP
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT L3222
|
| Hospital Charge Code |
905353222
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$235.45 |
| Rate for Payer: Adventist Health Commercial |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.67
|
| Rate for Payer: Blue Shield of California Commercial |
$213.01
|
| Rate for Payer: Blue Shield of California Commercial |
$140.44
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.90
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.45
|
| Rate for Payer: Vantage Medical Group Senior |
$235.45
|
|
|
HC SHOES MENS HIGHTOP
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT L3222
|
| Hospital Charge Code |
905353222
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
|
|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
905353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
905353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.48
|
| Rate for Payer: Blue Shield of California Commercial |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$64.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
915353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
915353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.48
|
| Rate for Payer: Blue Shield of California Commercial |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$64.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
915353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
905353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$36.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
915353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$36.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
905353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
905353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
915353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
905353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
915353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SHOE TRNSFR NEW SOLID STIRRUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L3630
|
| Hospital Charge Code |
905353630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC SHOE TRNSFR NEW SOLID STIRRUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L3630
|
| Hospital Charge Code |
915353630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
