|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
915353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.66
|
| Rate for Payer: Blue Shield of California Commercial |
$90.04
|
| Rate for Payer: Blue Shield of California EPN |
$59.29
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.66
|
| Rate for Payer: Blue Shield of California Commercial |
$90.04
|
| Rate for Payer: Blue Shield of California EPN |
$59.29
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL PAD REMOVABLE FOR SPUR
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT L3485
|
| Hospital Charge Code |
905353485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.40
|
| Rate for Payer: Blue Shield of California Commercial |
$78.23
|
| Rate for Payer: Blue Shield of California EPN |
$51.52
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO |
$74.20
|
| Rate for Payer: Cigna of CA PPO |
$74.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$53.00
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Other HMO |
$38.72
|
| Rate for Payer: United Healthcare HMO Rider |
$37.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC HEEL PAD REMOVABLE FOR SPUR
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT L3485
|
| Hospital Charge Code |
905353485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO |
$74.20
|
| Rate for Payer: Cigna of CA PPO |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$53.00
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Other HMO |
$38.72
|
| Rate for Payer: United Healthcare HMO Rider |
$37.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.72
|
|
|
HC HEEL PRTCTR STABLIZ WEDGE STRD
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
901698881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.35
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.20
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.00
|
| Rate for Payer: United Healthcare All Other HMO |
$133.00
|
| Rate for Payer: United Healthcare HMO Rider |
$133.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC HEEL PRTCTR STABLIZ WEDGE STRD
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
901698881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC HEEL PRTCTR W/STABLIZ WEDGE XL
|
Facility
|
IP
|
$353.80
|
|
| Hospital Charge Code |
901698880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$300.73 |
| Rate for Payer: Adventist Health Commercial |
$70.76
|
| Rate for Payer: Cash Price |
$194.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.52
|
| Rate for Payer: EPIC Health Plan Senior |
$141.52
|
| Rate for Payer: Galaxy Health WC |
$300.73
|
| Rate for Payer: Global Benefits Group Commercial |
$212.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.91
|
| Rate for Payer: Multiplan Commercial |
$283.04
|
| Rate for Payer: Networks By Design Commercial |
$229.97
|
| Rate for Payer: Prime Health Services Commercial |
$300.73
|
|
|
HC HEEL PRTCTR W/STABLIZ WEDGE XL
|
Facility
|
OP
|
$353.80
|
|
| Hospital Charge Code |
901698880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$300.73 |
| Rate for Payer: Adventist Health Commercial |
$70.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.27
|
| Rate for Payer: Cash Price |
$194.59
|
| Rate for Payer: Cigna of CA HMO |
$226.43
|
| Rate for Payer: Cigna of CA PPO |
$261.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.52
|
| Rate for Payer: EPIC Health Plan Senior |
$141.52
|
| Rate for Payer: Galaxy Health WC |
$300.73
|
| Rate for Payer: Global Benefits Group Commercial |
$212.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.66
|
| Rate for Payer: Multiplan Commercial |
$283.04
|
| Rate for Payer: Networks By Design Commercial |
$229.97
|
| Rate for Payer: Prime Health Services Commercial |
$300.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.90
|
| Rate for Payer: United Healthcare All Other HMO |
$176.90
|
| Rate for Payer: United Healthcare HMO Rider |
$176.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.73
|
| Rate for Payer: Vantage Medical Group Senior |
$300.73
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
915353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
915353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
915353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.66
|
| Rate for Payer: Blue Shield of California Commercial |
$90.04
|
| Rate for Payer: Blue Shield of California EPN |
$59.29
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.66
|
| Rate for Payer: Blue Shield of California Commercial |
$90.04
|
| Rate for Payer: Blue Shield of California EPN |
$59.29
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
915353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
905353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
905353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.50
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
915353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
915353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.50
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC HEEL WEDGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
905353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC HEEL WEDGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
915353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC HEEL WEDGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
915353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC HEEL WEDGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
905353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
