|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
OP
|
$6,408.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,524.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,524.40
|
| Rate for Payer: Cash Price |
$3,524.40
|
| Rate for Payer: Cash Price |
$3,524.40
|
| Rate for Payer: Cigna of CA HMO |
$4,101.12
|
| Rate for Payer: Cigna of CA PPO |
$4,741.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,446.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,446.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,563.20
|
| Rate for Payer: Galaxy Health WC |
$5,446.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,844.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,966.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,485.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,485.60
|
| Rate for Payer: Multiplan Commercial |
$5,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,165.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,446.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,446.80
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
IP
|
$6,408.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$5,446.80 |
| Rate for Payer: Adventist Health Commercial |
$1,281.60
|
| Rate for Payer: Cash Price |
$3,524.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,563.20
|
| Rate for Payer: Galaxy Health WC |
$5,446.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,441.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,966.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.92
|
| Rate for Payer: Multiplan Commercial |
$5,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,165.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,446.80
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$299.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$296.21
|
| Rate for Payer: Blue Shield of California EPN |
$195.54
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cigna of CA HMO |
$309.76
|
| Rate for Payer: Cigna of CA PPO |
$358.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$290.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$290.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ORBITS
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.60 |
| Max. Negotiated Rate |
$958.80 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$451.20
|
| Rate for Payer: Galaxy Health WC |
$958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$676.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$698.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.72
|
| Rate for Payer: Multiplan Commercial |
$902.40
|
| Rate for Payer: Networks By Design Commercial |
$733.20
|
| Rate for Payer: Prime Health Services Commercial |
$958.80
|
|
|
HC ORBITS
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$958.80 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$739.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.23
|
| Rate for Payer: Blue Shield of California Commercial |
$690.34
|
| Rate for Payer: Blue Shield of California EPN |
$455.71
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna of CA HMO |
$721.92
|
| Rate for Payer: Cigna of CA PPO |
$834.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$676.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$902.40
|
| Rate for Payer: Networks By Design Commercial |
$733.20
|
| Rate for Payer: Prime Health Services Commercial |
$958.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$676.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$676.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$2,285.65 |
| Rate for Payer: Adventist Health Commercial |
$1,102.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,984.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,306.85
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,285.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,285.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,882.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,151.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,613.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,285.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.36
|
| Rate for Payer: Multiplan Commercial |
$2,151.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
915352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.36
|
| Rate for Payer: Multiplan Commercial |
$2,151.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
915352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$2,285.65 |
| Rate for Payer: Adventist Health Commercial |
$1,102.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,984.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,306.85
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,285.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,285.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,882.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,151.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,613.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,285.65
|
|
|
HC ORTHOTIC FITTING TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900400049
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC ORTHOTIC FITTING TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900400049
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$123.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.70
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC ORTHOTICS LE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L2999
|
| Hospital Charge Code |
905302999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.76
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS LE EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L2999
|
| Hospital Charge Code |
905302999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTICS SPINAL EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905301499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.76
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS SPINAL EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905301499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTICS UE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905303999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.76
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS UE EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905303999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTIC TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
901300078
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$123.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.70
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC ORTHOTIC TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
901300078
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC OS ADHESIVE SPRY OSTOMY 3.2
|
Facility
|
IP
|
$70.52
|
|
| Hospital Charge Code |
901600178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.92
|
| Rate for Payer: Multiplan Commercial |
$56.42
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
|
