|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$897.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.78
|
| 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 |
$403.65
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$569.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$529.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Riverside University Health System MISP |
$358.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
IP
|
$1,791.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,253.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,137.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,056.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
OP
|
$1,791.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,343.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$867.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,041.82
|
| 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 |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO |
$1,146.24
|
| Rate for Payer: Cigna of CA PPO |
$1,325.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,522.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,522.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,253.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,137.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,056.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,253.70
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
| Rate for Payer: Riverside University Health System MISP |
$716.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.50
|
| Rate for Payer: United Healthcare All Other HMO |
$895.50
|
| Rate for Payer: United Healthcare HMO Rider |
$895.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,522.35
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
OP
|
$4,506.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$82.35 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$901.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$806.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,788.88
|
| Rate for Payer: Cash Price |
$2,027.70
|
| Rate for Payer: Cash Price |
$2,027.70
|
| Rate for Payer: Cash Price |
$2,027.70
|
| Rate for Payer: Cash Price |
$2,027.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,604.80
|
| Rate for Payer: Cigna of CA HMO |
$2,883.84
|
| Rate for Payer: Cigna of CA PPO |
$3,334.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,154.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$3,830.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,055.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,861.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,379.50
|
| Rate for Payer: Networks By Design Commercial |
$2,928.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.10
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,703.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,703.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
IP
|
$4,506.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$901.20 |
| Max. Negotiated Rate |
$4,055.40 |
| Rate for Payer: Adventist Health Commercial |
$901.20
|
| Rate for Payer: Cash Price |
$2,027.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,154.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.40
|
| Rate for Payer: Galaxy Health WC |
$3,830.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,055.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,861.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,658.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Multiplan Commercial |
$3,379.50
|
| Rate for Payer: Networks By Design Commercial |
$2,928.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.10
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.69 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.89
|
| Rate for Payer: Blue Shield of California Commercial |
$406.98
|
| Rate for Payer: Blue Shield of California EPN |
$256.46
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$581.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$581.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ORBITS
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,009.89
|
| Rate for Payer: Blue Shield of California EPN |
$636.39
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,122.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ORBITS
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,122.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.10
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.10
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.09
|
| Rate for Payer: Blue Shield of California Commercial |
$40.10
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.09
|
| Rate for Payer: Blue Shield of California Commercial |
$40.10
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,156.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.26
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,151.20
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,420.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.80
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| Rate for Payer: Networks By Design Commercial |
$1,747.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
915352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Adventist Health Commercial |
$1,102.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,564.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,156.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.26
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,151.20
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,285.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,285.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,420.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,075.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,613.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,285.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Adventist Health Commercial |
$1,102.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,564.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,156.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.26
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,151.20
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,285.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,285.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,420.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,075.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,613.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,285.65
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
915352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.80 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Adventist Health Commercial |
$537.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,156.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.26
|
| Rate for Payer: Cash Price |
$1,210.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,151.20
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,420.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,586.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.80
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| Rate for Payer: Networks By Design Commercial |
$1,747.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
|
|
HC ORTHOTIC FITTING TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900400049
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC ORTHOTIC FITTING TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900400049
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Riverside University Health System MISP |
$88.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
|
HC ORTHOTIC FITTING/TRAINING 15 MIN OT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
905104150
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC ORTHOTIC FITTING/TRAINING 15 MIN OT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
905104150
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Riverside University Health System MISP |
$88.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
|
HC ORTHOTIC FITTING/TRAINING 15 MIN PT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900417504
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC ORTHOTIC FITTING/TRAINING 15 MIN PT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900417504
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.86 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Riverside University Health System MISP |
$88.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
