|
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 |
$312.85
|
| 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 |
$770.04
|
| Rate for Payer: Blue Shield of California Commercial |
$553.20
|
| Rate for Payer: Blue Shield of California Commercial |
$836.40
|
| Rate for Payer: Cash Price |
$540.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| 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 |
$312.85
|
| 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 |
$320.85
|
| Rate for Payer: Blue Shield of California Commercial |
$230.50
|
| Rate for Payer: Blue Shield of California Commercial |
$348.50
|
| Rate for Payer: Cash Price |
$225.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| 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: Cigna of CA HMO |
$544.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.85
|
| 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 |
$545.45
|
| Rate for Payer: Blue Shield of California Commercial |
$391.85
|
| Rate for Payer: Blue Shield of California Commercial |
$592.45
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| 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 SOK KARIUS TEST
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.28 |
| Max. Negotiated Rate |
$12,564.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,564.50
|
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,126.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.20
|
| Rate for Payer: Blue Shield of California Commercial |
$737.60
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,338.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2,338.82
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,486.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,126.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,976.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,679.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,849.11
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,722.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,722.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,722.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,722.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,126.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.20
|
|
|
HC SOK KARIUS TEST
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| 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 |
$118.95
|
| 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
|
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 |
$110.77
|
| Rate for Payer: Blue Shield of California Commercial |
$92.78
|
| Rate for Payer: Blue Shield of California Commercial |
$140.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| 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 |
$118.95
|
| 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
|
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: Vantage Medical Group Senior |
$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 |
$110.77
|
| Rate for Payer: Blue Shield of California Commercial |
$92.78
|
| Rate for Payer: Blue Shield of California Commercial |
$140.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| 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
|
|
|
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 |
$73.24
|
| Rate for Payer: Blue Shield of California Commercial |
$93.05
|
| Rate for Payer: Blue Shield of California Commercial |
$61.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| 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 |
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 |
$73.24
|
| Rate for Payer: Blue Shield of California Commercial |
$93.05
|
| Rate for Payer: Blue Shield of California Commercial |
$61.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| 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 |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| 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 |
$78.65
|
| 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 |
915353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| 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 |
$78.65
|
| 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 WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
915353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
915353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.37
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
915353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.37
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
915353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| 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 |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.81
|
| Rate for Payer: Blue Shield of California Commercial |
$39.19
|
| Rate for Payer: Blue Shield of California Commercial |
$55.78
|
| Rate for Payer: Blue Shield of California Commercial |
$59.24
|
| Rate for Payer: Blue Shield of California Commercial |
$84.34
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.76
|
| Rate for Payer: EPIC Health Plan Senior |
$88.51
|
| Rate for Payer: EPIC Health Plan Senior |
$88.51
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$80.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$80.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
