|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.66
|
| Rate for Payer: Blue Shield of California Commercial |
$239.11
|
| Rate for Payer: Blue Shield of California EPN |
$157.46
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.66
|
| Rate for Payer: Blue Shield of California Commercial |
$239.11
|
| Rate for Payer: Blue Shield of California EPN |
$157.46
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT PALATE
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC SOFT PALATE
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.94
|
| Rate for Payer: Blue Shield of California Commercial |
$726.44
|
| Rate for Payer: Blue Shield of California EPN |
$479.55
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.04
|
| Rate for Payer: Blue Shield of California Commercial |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$786.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$786.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$442.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.52
|
| Rate for Payer: Blue Shield of California Commercial |
$451.57
|
| Rate for Payer: Blue Shield of California EPN |
$298.35
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,327.79 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$914.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,327.79
|
| Rate for Payer: Blue Shield of California Commercial |
$933.25
|
| Rate for Payer: Blue Shield of California EPN |
$616.59
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cigna of CA HMO |
$892.80
|
| Rate for Payer: Cigna of CA PPO |
$1,032.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Senior |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$837.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,185.75 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$863.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$742.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$787.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$736.92
|
| Rate for Payer: Blue Shield of California Commercial |
$802.80
|
| Rate for Payer: Blue Shield of California EPN |
$530.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$768.00
|
| Rate for Payer: Cigna of CA PPO |
$888.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$742.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$600.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.05
|
| Rate for Payer: Blue Shield of California Commercial |
$334.50
|
| Rate for Payer: Blue Shield of California EPN |
$221.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$557.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.99
|
| Rate for Payer: Blue Shield of California Commercial |
$568.65
|
| Rate for Payer: Blue Shield of California EPN |
$375.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna of CA HMO |
$544.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO |
$425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$425.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
915353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.99
|
| Rate for Payer: Blue Shield of California Commercial |
$135.05
|
| Rate for Payer: Blue Shield of California EPN |
$88.94
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.99
|
| Rate for Payer: Blue Shield of California Commercial |
$135.05
|
| Rate for Payer: Blue Shield of California EPN |
$88.94
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
915353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$49.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.08
|
| Rate for Payer: Blue Shield of California Commercial |
$89.30
|
| Rate for Payer: Blue Shield of California EPN |
$58.81
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
915353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$49.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.08
|
| Rate for Payer: Blue Shield of California Commercial |
$89.30
|
| Rate for Payer: Blue Shield of California EPN |
$58.81
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
915353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
|
