|
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 |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| 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 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 |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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: 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 |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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
|
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 |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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 |
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 |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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 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: United Healthcare HMO Rider |
$17.87
|
| 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 |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| 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 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 |
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 |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| 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 |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| 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 |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| 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 SACH
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
915353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
915353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,715.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,605.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.46
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,618.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
915368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
915368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.01
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.50
|
| Rate for Payer: United Healthcare All Other HMO |
$234.50
|
| Rate for Payer: United Healthcare HMO Rider |
$234.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,437.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.61
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,858.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,858.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,858.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,437.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.61
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,858.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,858.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,858.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.01
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.50
|
| Rate for Payer: United Healthcare All Other HMO |
$234.50
|
| Rate for Payer: United Healthcare HMO Rider |
$234.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
