|
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 |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| 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: 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: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$38.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| 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 |
$38.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| 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 |
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 |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| 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: 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: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,078.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| 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
|
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 |
$2,078.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| 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 |
$1,579.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,078.60
|
| 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: 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: InnovAge PACE Commercial |
$1,344.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,882.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| 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 |
$1,579.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,078.60
|
| 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: 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: InnovAge PACE Commercial |
$1,344.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,882.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| 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 |
$83.82 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
905104150
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| 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 |
905103150
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
900417504
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$231.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| 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 |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| 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: 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: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
$231.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| 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 |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| 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: 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: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
$231.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| 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 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 |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| 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: 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: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$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 ORTHOTIC TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
901300078
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| 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
|
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 |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$43.09
|
| 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: 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: InnovAge PACE Commercial |
$35.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
