|
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 |
$227.03
|
| Rate for Payer: Cash Price |
$159.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$247.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$224.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.74
|
| 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
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
$136.50
|
| 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
|
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 |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
$136.50
|
| 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
|
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 |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 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 |
$73.85
|
| Rate for Payer: Blue Shield of California Commercial |
$93.82
|
| Rate for Payer: Blue Shield of California Commercial |
$61.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 |
$79.30
|
| 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 |
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 |
$73.85
|
| Rate for Payer: Blue Shield of California Commercial |
$93.82
|
| Rate for Payer: Blue Shield of California Commercial |
$61.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| 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 |
$79.30
|
| 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
|
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 |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$60.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| 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 |
$78.00
|
| 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
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
905353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| 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 |
$78.00
|
| 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: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| 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 |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$60.84
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| 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 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 |
$30.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.45
|
| Rate for Payer: Blue Shield of California Commercial |
$25.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| 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 |
905353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$30.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.45
|
| Rate for Payer: Blue Shield of California Commercial |
$25.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| 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 |
$32.50
|
| 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 |
915353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| 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 |
$32.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| 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 |
$110.50
|
| 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
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
915353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| 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 |
$110.50
|
| 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 |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$86.19
|
| Rate for Payer: Blue Shield of California Commercial |
$130.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| 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
|
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: 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 |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$86.19
|
| Rate for Payer: Blue Shield of California Commercial |
$130.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| 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 |
$165.49 |
| 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 |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,678.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,100.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.37
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,830.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| 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/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,660.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,830.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,660.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,542.85
|
| 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 |
$437.29
|
| 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 |
$343.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| 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
|
|
