|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.50
|
| Rate for Payer: Blue Shield of California Commercial |
$39.30
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,659.60 |
| Max. Negotiated Rate |
$15,933.00 |
| Rate for Payer: Adventist Health Commercial |
$1,659.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,563.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,223.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,638.40
|
| Rate for Payer: Cigna of CA HMO |
$5,393.70
|
| Rate for Payer: Cigna of CA PPO |
$6,140.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,053.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,053.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,808.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,319.20
|
| Rate for Payer: Galaxy Health WC |
$7,053.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,468.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,269.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,012.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,895.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,808.60
|
| Rate for Payer: Multiplan Commercial |
$6,223.50
|
| Rate for Payer: Networks By Design Commercial |
$5,393.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,053.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,978.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,053.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,053.30
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,659.60 |
| Max. Negotiated Rate |
$7,468.20 |
| Rate for Payer: Adventist Health Commercial |
$1,659.60
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,638.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,808.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,319.20
|
| Rate for Payer: Galaxy Health WC |
$7,053.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,468.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,269.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,895.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Multiplan Commercial |
$6,223.50
|
| Rate for Payer: Networks By Design Commercial |
$5,393.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,053.30
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
OP
|
$6,638.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.60 |
| Max. Negotiated Rate |
$9,562.00 |
| Rate for Payer: Adventist Health Commercial |
$1,327.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,650.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,978.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,987.10
|
| Rate for Payer: Cash Price |
$2,987.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,310.40
|
| Rate for Payer: Cigna of CA HMO |
$4,314.70
|
| Rate for Payer: Cigna of CA PPO |
$4,912.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,642.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,642.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,646.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,655.20
|
| Rate for Payer: Galaxy Health WC |
$5,642.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,974.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,215.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,409.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,916.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,646.60
|
| Rate for Payer: Multiplan Commercial |
$4,978.50
|
| Rate for Payer: Networks By Design Commercial |
$4,314.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,642.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,655.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,642.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,642.30
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
IP
|
$6,638.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.60 |
| Max. Negotiated Rate |
$5,974.20 |
| Rate for Payer: Adventist Health Commercial |
$1,327.60
|
| Rate for Payer: Cash Price |
$2,987.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,310.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,646.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,655.20
|
| Rate for Payer: Galaxy Health WC |
$5,642.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,974.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,215.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,916.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.60
|
| Rate for Payer: Multiplan Commercial |
$4,978.50
|
| Rate for Payer: Networks By Design Commercial |
$4,314.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,642.30
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
OP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$842.66 |
| Max. Negotiated Rate |
$2,315.70 |
| Rate for Payer: Adventist Health Commercial |
$1,054.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,415.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,929.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,496.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,063.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,058.40
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,187.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,187.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,315.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,633.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$934.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,518.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,054.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,801.10
|
| Rate for Payer: Multiplan Commercial |
$1,929.75
|
| Rate for Payer: Networks By Design Commercial |
$1,286.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,029.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,543.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,187.05
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
IP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$514.60 |
| Max. Negotiated Rate |
$2,315.70 |
| Rate for Payer: Adventist Health Commercial |
$514.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,063.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,058.40
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,315.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,633.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,518.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.60
|
| Rate for Payer: Multiplan Commercial |
$1,929.75
|
| Rate for Payer: Networks By Design Commercial |
$1,672.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.59
|
| Rate for Payer: Blue Shield of California Commercial |
$202.10
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health System MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$202.10
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.59
|
| Rate for Payer: Blue Shield of California Commercial |
$202.10
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health System MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$202.10
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
915353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.54
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
915353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.54
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
915353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
915353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
915353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.97
|
| Rate for Payer: Blue Shield of California Commercial |
$97.84
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.97
|
| Rate for Payer: Blue Shield of California Commercial |
$97.84
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
