|
HC ORTHOTIC FITTING/TRAINING 15 MIN PT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
905103150
|
|
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 PT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
905103150
|
|
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 ORTHOTICS LE EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L2999
|
| Hospital Charge Code |
905302999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTICS LE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L2999
|
| Hospital Charge Code |
905302999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS SPINAL EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905301499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTICS SPINAL EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905301499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS UE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905303999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC ORTHOTICS UE EVALUATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905303999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC ORTHOTIC TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
901300078
|
|
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 TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
901300078
|
|
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 OS ADHESIVE SPRY OSTOMY 3.2
|
Facility
|
IP
|
$70.52
|
|
| Hospital Charge Code |
901600178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Central Health Plan Commercial |
$56.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Multiplan Commercial |
$52.89
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
|
|
HC OS ADHESIVE SPRY OSTOMY 3.2
|
Facility
|
OP
|
$70.52
|
|
| Hospital Charge Code |
901600178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.02
|
| Rate for Payer: Blue Shield of California Commercial |
$44.71
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Central Health Plan Commercial |
$56.42
|
| Rate for Payer: Cigna of CA HMO |
$45.13
|
| Rate for Payer: Cigna of CA PPO |
$52.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$52.89
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
| Rate for Payer: Riverside University Health System MISP |
$28.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.26
|
| Rate for Payer: United Healthcare All Other HMO |
$35.26
|
| Rate for Payer: United Healthcare HMO Rider |
$35.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.94
|
| Rate for Payer: Vantage Medical Group Senior |
$59.94
|
|
|
HC OS BARRIER 2 3/4" FLANG CUTFIT
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC OS BARRIER 2 3/4" FLANG CUTFIT
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.46
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC OS BARRIER 2 3/4" FLANGE 57MM
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Central Health Plan Commercial |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$2.99
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.87
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Riverside University Health System MISP |
$1.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Vantage Medical Group Senior |
$3.97
|
|
|
HC OS BARRIER 2 3/4" FLANGE 57MM
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Central Health Plan Commercial |
$3.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.87
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
|
|
HC OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
