|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Adventist Health Commercial |
$364.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.49
|
| Rate for Payer: Blue Shield of California Commercial |
$656.82
|
| Rate for Payer: Blue Shield of California EPN |
$432.54
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$756.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$756.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.00
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.50
|
| Rate for Payer: Vantage Medical Group Senior |
$756.50
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
915353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
|
|
HC LIFT HEEL AND SOLE CORK
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.32
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Networks By Design Commercial |
$146.50
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
|
|
HC LIFT HEEL AND SOLE CORK
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$249.05 |
| Rate for Payer: Adventist Health Commercial |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.71
|
| Rate for Payer: Blue Shield of California Commercial |
$216.23
|
| Rate for Payer: Blue Shield of California EPN |
$142.40
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.10
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Networks By Design Commercial |
$146.50
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.05
|
| Rate for Payer: Vantage Medical Group Senior |
$249.05
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.31
|
| Rate for Payer: Blue Shield of California Commercial |
$123.98
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
905353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.31
|
| Rate for Payer: Blue Shield of California Commercial |
$123.98
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
905353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC LIFT HEEL PER INCH
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3334
|
| Hospital Charge Code |
905353334
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC LIFT HEEL PER INCH
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3334
|
| Hospital Charge Code |
915353334
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.34
|
| Rate for Payer: Blue Shield of California Commercial |
$59.04
|
| Rate for Payer: Blue Shield of California EPN |
$38.88
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC LIFT HEEL PER INCH
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3334
|
| Hospital Charge Code |
915353334
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC LIFT HEEL PER INCH
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3334
|
| Hospital Charge Code |
905353334
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.34
|
| Rate for Payer: Blue Shield of California Commercial |
$59.04
|
| Rate for Payer: Blue Shield of California EPN |
$38.88
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC LIFT HEEL TAPPERED TO MET/INCH
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT L3300
|
| Hospital Charge Code |
915353300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$42.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.66
|
| Rate for Payer: Blue Shield of California Commercial |
$76.01
|
| Rate for Payer: Blue Shield of California EPN |
$50.06
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$72.10
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.10
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$51.50
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.66
|
| Rate for Payer: United Healthcare All Other HMO |
$37.63
|
| Rate for Payer: United Healthcare HMO Rider |
$36.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.55
|
| Rate for Payer: Vantage Medical Group Senior |
$87.55
|
|
|
HC LIFT HEEL TAPPERED TO MET/INCH
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT L3300
|
| Hospital Charge Code |
905353300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$72.10
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$51.50
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.66
|
| Rate for Payer: United Healthcare All Other HMO |
$37.63
|
| Rate for Payer: United Healthcare HMO Rider |
$36.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.73
|
|
|
HC LIFT HEEL TAPPERED TO MET/INCH
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT L3300
|
| Hospital Charge Code |
915353300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$72.10
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$51.50
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.66
|
| Rate for Payer: United Healthcare All Other HMO |
$37.63
|
| Rate for Payer: United Healthcare HMO Rider |
$36.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.73
|
|
|
HC LIFT HEEL TAPPERED TO MET/INCH
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT L3300
|
| Hospital Charge Code |
905353300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$42.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.66
|
| Rate for Payer: Blue Shield of California Commercial |
$76.01
|
| Rate for Payer: Blue Shield of California EPN |
$50.06
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$72.10
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.10
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$51.50
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.66
|
| Rate for Payer: United Healthcare All Other HMO |
$37.63
|
| Rate for Payer: United Healthcare HMO Rider |
$36.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.55
|
| Rate for Payer: Vantage Medical Group Senior |
$87.55
|
|
|
HC LIFT INSIDE SHOE TAPERED
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
915353332
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.26
|
| Rate for Payer: Blue Shield of California Commercial |
$132.84
|
| Rate for Payer: Blue Shield of California EPN |
$87.48
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC LIFT INSIDE SHOE TAPERED
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
915353332
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
|
|
HC LIFT INSIDE SHOE TAPERED
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
905353332
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.26
|
| Rate for Payer: Blue Shield of California Commercial |
$132.84
|
| Rate for Payer: Blue Shield of California EPN |
$87.48
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC LIFT INSIDE SHOE TAPERED
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
905353332
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
|
|
HC LIGATION/BIOPSY,TEMP ARTERY
|
Facility
|
OP
|
$6,055.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
900501523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,211.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: Cigna of CA HMO |
$3,875.20
|
| Rate for Payer: Cigna of CA PPO |
$4,480.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,146.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,633.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,844.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,935.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,146.75
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,027.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,027.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,027.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,027.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LIGATION/BIOPSY,TEMP ARTERY
|
Facility
|
IP
|
$6,055.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
900501523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,211.00 |
| Max. Negotiated Rate |
$5,146.75 |
| Rate for Payer: Adventist Health Commercial |
$1,211.00
|
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,422.00
|
| Rate for Payer: Galaxy Health WC |
$5,146.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,633.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,748.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.20
|
| Rate for Payer: Multiplan Commercial |
$4,844.00
|
| Rate for Payer: Networks By Design Commercial |
$3,935.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,146.75
|
|
|
HC LIGATION DIV/EXC VARICOSEVEIN
|
Facility
|
IP
|
$12,821.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
900501325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,564.20 |
| Max. Negotiated Rate |
$10,897.85 |
| Rate for Payer: Adventist Health Commercial |
$2,564.20
|
| Rate for Payer: Cash Price |
$5,769.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,128.40
|
| Rate for Payer: Galaxy Health WC |
$10,897.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,692.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,884.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,936.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,077.04
|
| Rate for Payer: Multiplan Commercial |
$10,256.80
|
| Rate for Payer: Networks By Design Commercial |
$8,333.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,897.85
|
|
|
HC LIGATION DIV/EXC VARICOSEVEIN
|
Facility
|
OP
|
$12,821.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
900501325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$357.92 |
| Max. Negotiated Rate |
$10,897.85 |
| Rate for Payer: Adventist Health Commercial |
$2,564.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$5,769.45
|
| Rate for Payer: Cash Price |
$5,769.45
|
| Rate for Payer: Cash Price |
$5,769.45
|
| Rate for Payer: Cigna of CA HMO |
$8,205.44
|
| Rate for Payer: Cigna of CA PPO |
$9,487.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,897.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,692.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,077.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,256.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,333.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,897.85
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,692.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,410.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,410.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,410.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,410.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.43 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna of CA HMO |
$1,899.52
|
| Rate for Payer: Cigna of CA PPO |
$2,196.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,522.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,979.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,374.40
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,929.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,522.80
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,484.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,484.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,484.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
