|
HC SHOE MOD-OFF SET HEELS
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5506
|
| Hospital Charge Code |
905365506
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC SHOE MOD-ROCKER BOTTOM
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT A5503
|
| Hospital Charge Code |
905365503
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC SHOE MOD-ROCKER BOTTOM
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT A5503
|
| Hospital Charge Code |
915365503
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC SHOE MOD-ROCKER BOTTOM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT A5503
|
| Hospital Charge Code |
905365503
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.18
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC SHOE MOD-ROCKER BOTTOM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT A5503
|
| Hospital Charge Code |
915365503
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.18
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC SHOE MOD-SOLE WEDGE
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT A5504
|
| Hospital Charge Code |
915365504
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
|
|
HC SHOE MOD-SOLE WEDGE
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT A5504
|
| Hospital Charge Code |
905365504
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
|
|
HC SHOE MOD-SOLE WEDGE
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT A5504
|
| Hospital Charge Code |
905365504
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.57
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna of CA HMO |
$216.32
|
| Rate for Payer: Cigna of CA PPO |
$250.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.00
|
| Rate for Payer: United Healthcare All Other HMO |
$169.00
|
| Rate for Payer: United Healthcare HMO Rider |
$169.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.30
|
| Rate for Payer: Vantage Medical Group Senior |
$287.30
|
|
|
HC SHOE MOD-SOLE WEDGE
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT A5504
|
| Hospital Charge Code |
915365504
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.57
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna of CA HMO |
$216.32
|
| Rate for Payer: Cigna of CA PPO |
$250.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.00
|
| Rate for Payer: United Healthcare All Other HMO |
$169.00
|
| Rate for Payer: United Healthcare HMO Rider |
$169.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.30
|
| Rate for Payer: Vantage Medical Group Senior |
$287.30
|
|
|
HC SHOE MOLDED PLASTIZOTE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT L3252
|
| Hospital Charge Code |
905353252
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: Galaxy Health WC |
$262.65
|
| Rate for Payer: Adventist Health Commercial |
$126.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.97
|
| Rate for Payer: Blue Shield of California Commercial |
$228.04
|
| Rate for Payer: Blue Shield of California EPN |
$150.17
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cigna of CA HMO |
$216.30
|
| Rate for Payer: Cigna of CA PPO |
$216.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$123.60
|
| Rate for Payer: Global Benefits Group Commercial |
$185.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Networks By Design Commercial |
$154.50
|
| Rate for Payer: Prime Health Services Commercial |
$262.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.97
|
| Rate for Payer: United Healthcare All Other HMO |
$112.88
|
| Rate for Payer: United Healthcare HMO Rider |
$110.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
|
|
HC SHOE MOLDED PLASTIZOTE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT L3252
|
| Hospital Charge Code |
905353252
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cigna of CA HMO |
$216.30
|
| Rate for Payer: Cigna of CA PPO |
$216.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$123.60
|
| Rate for Payer: Galaxy Health WC |
$262.65
|
| Rate for Payer: Global Benefits Group Commercial |
$185.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.16
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Networks By Design Commercial |
$154.50
|
| Rate for Payer: Prime Health Services Commercial |
$262.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.97
|
| Rate for Payer: United Healthcare All Other HMO |
$112.88
|
| Rate for Payer: United Healthcare HMO Rider |
$110.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.20
|
|
|
HC SHOE OXFORD/BRACE MAN
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L3225
|
| Hospital Charge Code |
905353225
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC SHOE OXFORD/BRACE MAN
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L3225
|
| Hospital Charge Code |
915353225
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC SHOE OXFORD/BRACE MAN
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L3225
|
| Hospital Charge Code |
915353225
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC SHOE OXFORD/BRACE MAN
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L3225
|
| Hospital Charge Code |
905353225
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC SHOE OXFORD CHILD
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L3202
|
| Hospital Charge Code |
905353202
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.97
|
| Rate for Payer: Blue Shield of California Commercial |
$78.97
|
| Rate for Payer: Blue Shield of California EPN |
$52.00
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC SHOE OXFORD CHILD
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L3202
|
| Hospital Charge Code |
905353202
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC SHOE OXFORD INFANT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT L3201
|
| Hospital Charge Code |
905353201
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.18
|
| Rate for Payer: Blue Shield of California Commercial |
$71.59
|
| Rate for Payer: Blue Shield of California EPN |
$47.14
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO |
$67.90
|
| Rate for Payer: Cigna of CA PPO |
$67.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Senior |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.40
|
| Rate for Payer: United Healthcare All Other HMO |
$35.43
|
| Rate for Payer: United Healthcare HMO Rider |
$34.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC SHOE OXFORD INFANT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT L3201
|
| Hospital Charge Code |
905353201
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO |
$67.90
|
| Rate for Payer: Cigna of CA PPO |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Senior |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.40
|
| Rate for Payer: United Healthcare All Other HMO |
$35.43
|
| Rate for Payer: United Healthcare HMO Rider |
$34.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
|
|
HC SHOE OXFORD JUNIOR
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT L3203
|
| Hospital Charge Code |
905353203
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Adventist Health Commercial |
$117.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.65
|
| Rate for Payer: Blue Shield of California Commercial |
$211.07
|
| Rate for Payer: Blue Shield of California EPN |
$139.00
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO |
$200.20
|
| Rate for Payer: Cigna of CA PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.34
|
| Rate for Payer: United Healthcare All Other HMO |
$104.48
|
| Rate for Payer: United Healthcare HMO Rider |
$102.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC SHOE OXFORD JUNIOR
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT L3203
|
| Hospital Charge Code |
905353203
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO |
$200.20
|
| Rate for Payer: Cigna of CA PPO |
$200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.34
|
| Rate for Payer: United Healthcare All Other HMO |
$104.48
|
| Rate for Payer: United Healthcare HMO Rider |
$102.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.67
|
|
|
HC SHOE POST-OP FEMALE LARGE
|
Facility
|
OP
|
$38.13
|
|
| Hospital Charge Code |
901606726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.42
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC SHOE POST-OP FEMALE LARGE
|
Facility
|
IP
|
$38.13
|
|
| Hospital Charge Code |
901606726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
|
HC SHOE POST-OP FEMALE MEDIUM
|
Facility
|
OP
|
$38.13
|
|
| Hospital Charge Code |
901606725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.42
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC SHOE POST-OP FEMALE MEDIUM
|
Facility
|
IP
|
$38.13
|
|
| Hospital Charge Code |
901606725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
