|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
915353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
915353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.99
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SHOE CUSTOM FITTED PLASTIZOTE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L3253
|
| Hospital Charge Code |
905353253
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC SHOE CUSTOM FITTED PLASTIZOTE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3253
|
| Hospital Charge Code |
905353253
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC SHOE CUSTOM PROSTHETIC EA
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT L3250
|
| Hospital Charge Code |
905353250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$866.16
|
| Rate for Payer: Blue Shield of California EPN |
$544.32
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Cigna of CA HMO |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$756.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.32
|
| Rate for Payer: United Healthcare All Other HMO |
$394.52
|
| Rate for Payer: United Healthcare HMO Rider |
$385.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.70
|
|
|
HC SHOE CUSTOM PROSTHETIC EA
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT L3250
|
| Hospital Charge Code |
905353250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$294.15 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Adventist Health Commercial |
$442.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$628.24
|
| Rate for Payer: Blue Shield of California Commercial |
$866.16
|
| Rate for Payer: Blue Shield of California EPN |
$544.32
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Cigna of CA HMO |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$756.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$918.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$756.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$540.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Riverside University Health System MISP |
$432.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$648.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.32
|
| Rate for Payer: United Healthcare All Other HMO |
$394.52
|
| Rate for Payer: United Healthcare HMO Rider |
$385.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$918.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.00
|
| Rate for Payer: Vantage Medical Group Senior |
$918.00
|
|
|
HC SHOE HIGHTOP CHILD
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L3206
|
| Hospital Charge Code |
905353206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Riverside University Health System MISP |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC SHOE HIGHTOP CHILD
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L3206
|
| Hospital Charge Code |
905353206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC SHOE HIGHTOP INFANT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT L3204
|
| Hospital Charge Code |
905353204
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.42
|
| Rate for Payer: Blue Shield of California Commercial |
$77.79
|
| Rate for Payer: Blue Shield of California EPN |
$48.89
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: Cigna of CA HMO |
$67.90
|
| Rate for Payer: Cigna of CA PPO |
$67.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Senior |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Networks By Design Commercial |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Riverside University Health System MISP |
$38.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.40
|
| Rate for Payer: United Healthcare All Other HMO |
$35.43
|
| Rate for Payer: United Healthcare HMO Rider |
$34.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC SHOE HIGHTOP INFANT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT L3204
|
| Hospital Charge Code |
905353204
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Blue Shield of California Commercial |
$77.79
|
| Rate for Payer: Blue Shield of California EPN |
$48.89
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: Cigna of CA HMO |
$67.90
|
| Rate for Payer: Cigna of CA PPO |
$67.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Senior |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.40
|
| Rate for Payer: United Healthcare All Other HMO |
$35.43
|
| Rate for Payer: United Healthcare HMO Rider |
$34.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
|
|
HC SHOE HIGHTOP JUNIOR
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L3207
|
| Hospital Charge Code |
905353207
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC SHOE HIGHTOP JUNIOR
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L3207
|
| Hospital Charge Code |
905353207
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Riverside University Health System MISP |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC SHOE LADIES DEPTH INLAY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3216
|
| Hospital Charge Code |
905353216
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.11
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Riverside University Health System MISP |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC SHOE LADIES DEPTH INLAY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3216
|
| Hospital Charge Code |
905353216
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC SHOE LADIES DEPTH INLAY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3216
|
| Hospital Charge Code |
915353216
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SHOE LADIES DEPTH INLAY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3216
|
| Hospital Charge Code |
915353216
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SHOE MOD-METATARSAL BAR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT A5505
|
| Hospital Charge Code |
905365505
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SHOE MOD-METATARSAL BAR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT A5505
|
| Hospital Charge Code |
905365505
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$82.83 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.83
|
| 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 Exchange |
$24.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.09
|
| Rate for Payer: Blue Shield of California Commercial |
$31.70
|
| Rate for Payer: Blue Shield of California EPN |
$19.95
|
| 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 |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| 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: 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 SHOE MOD-METATARSAL BAR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT A5505
|
| Hospital Charge Code |
915365505
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$82.83 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.83
|
| 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 Exchange |
$24.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.09
|
| Rate for Payer: Blue Shield of California Commercial |
$31.70
|
| Rate for Payer: Blue Shield of California EPN |
$19.95
|
| 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 |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| 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: 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 SHOE MOD-METATARSAL BAR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT A5505
|
| Hospital Charge Code |
915365505
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SHOE MOD-OFF SET HEELS
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5506
|
| Hospital Charge Code |
905365506
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.69
|
| Rate for Payer: Blue Shield of California Commercial |
$86.86
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC SHOE MOD-OFF SET HEELS
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5506
|
| Hospital Charge Code |
905365506
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC SHOE MOD-OFF SET HEELS
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5506
|
| Hospital Charge Code |
915365506
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC SHOE MOD-OFF SET HEELS
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5506
|
| Hospital Charge Code |
915365506
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.69
|
| Rate for Payer: Blue Shield of California Commercial |
$86.86
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC SHOE MOD-ROCKER BOTTOM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT A5503
|
| Hospital Charge Code |
905365503
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$36.33 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.04
|
| Rate for Payer: Blue Shield of California Commercial |
$178.79
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Riverside University Health System MISP |
$112.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
