|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
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 |
$219.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.27
|
| Rate for Payer: Blue Shield of California Commercial |
$474.89
|
| Rate for Payer: Blue Shield of California Commercial |
$719.66
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$789.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$676.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$716.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$507.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$789.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$716.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$665.52
|
| 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 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 |
$30.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.45
|
| Rate for Payer: Blue Shield of California Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC 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 |
$30.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.45
|
| Rate for Payer: Blue Shield of California Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC 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 |
$1,627.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,067.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.32
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| 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 |
915352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| 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 |
$1,747.85
|
| 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 |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| 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 |
$1,747.85
|
| 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 |
$1,627.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,067.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.32
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| 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
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900400049
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$123.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 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 |
$135.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 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 |
$181.59
|
| Rate for Payer: Blue Shield of California Commercial |
$152.10
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 |
$195.00
|
| 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
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905301499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 |
$195.00
|
| 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 |
$181.59
|
| Rate for Payer: Blue Shield of California Commercial |
$152.10
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 |
$195.00
|
| 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 |
$181.59
|
| Rate for Payer: Blue Shield of California Commercial |
$152.10
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$123.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 |
$135.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 |
$31.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.36
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.61
|
| 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
|
|
|
HC OS ADHESIVE SPRY OSTOMY 3.2
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$46.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.25
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cigna of CA HMO |
$45.13
|
| Rate for Payer: Cigna of CA PPO |
$52.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.36
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.36
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.26
|
| Rate for Payer: United Healthcare All Other HMO |
$35.26
|
| Rate for Payer: United Healthcare HMO Rider |
$35.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.94
|
| Rate for Payer: Vantage Medical Group Senior |
$59.94
|
|
|
HC OS BARRIER 2 3/4" FLANG CUTFIT
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.58
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
