|
HC SOLE FULL SHOE ADD
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.45
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health System MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
915353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
915353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.04
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$49.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$97.04
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Riverside University Health System MISP |
$48.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
915353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$49.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$97.04
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Riverside University Health System MISP |
$48.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.04
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.41
|
| Rate for Payer: United Healthcare All Other HMO |
$44.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.63
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
915353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
915353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
915353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
915353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$80.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$80.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.02
|
| Rate for Payer: Blue Shield of California Commercial |
$53.55
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Blue Shield of California EPN |
$48.04
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.76
|
| Rate for Payer: EPIC Health Plan Senior |
$88.51
|
| Rate for Payer: EPIC Health Plan Senior |
$88.51
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80.46
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$85.29
|
| Rate for Payer: Prime Health Services Medicare |
$85.29
|
| Rate for Payer: Riverside University Health System MISP |
$88.51
|
| Rate for Payer: Riverside University Health System MISP |
$88.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$80.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$80.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC SOLVENT DETERGENT POOLED PLASM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904771
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$70.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.12
|
| Rate for Payer: Blue Shield of California Commercial |
$51.35
|
| Rate for Payer: Blue Shield of California EPN |
$32.32
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.24
|
| Rate for Payer: EPIC Health Plan Senior |
$77.50
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$70.45
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Prime Health Services Medicare |
$74.68
|
| Rate for Payer: Riverside University Health System MISP |
$77.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.45
|
|
|
HC SOLVENT DETERGENT POOLED PLASM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904771
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Senior |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
IP
|
$23.81
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Central Health Plan Commercial |
$19.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$20.24
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.24
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
OP
|
$23.81
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$303.14 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.14
|
| Rate for Payer: Blue Shield of California Commercial |
$15.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.45
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Central Health Plan Commercial |
$19.05
|
| Rate for Payer: Cigna of CA HMO |
$15.24
|
| Rate for Payer: Cigna of CA PPO |
$17.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$20.24
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.98
|
| Rate for Payer: Prime Health Services Commercial |
$20.24
|
| Rate for Payer: Prime Health Services Medicare |
$32.84
|
| Rate for Payer: Riverside University Health System MISP |
$34.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$274.74 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.74
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$6.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.83
|
| Rate for Payer: EPIC Health Plan Senior |
$29.89
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.17
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Prime Health Services Medicare |
$28.80
|
| Rate for Payer: Riverside University Health System MISP |
$29.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SOM 199PC 86301
|
Facility
|
IP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Central Health Plan Commercial |
$23.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$25.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
| Rate for Payer: Networks By Design Commercial |
$19.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.34
|
|
|
HC SOM 199PC 86301
|
Facility
|
OP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$210.33 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.33
|
| Rate for Payer: Blue Shield of California Commercial |
$18.78
|
| Rate for Payer: Blue Shield of California EPN |
$11.83
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Central Health Plan Commercial |
$23.85
|
| Rate for Payer: Cigna of CA HMO |
$19.08
|
| Rate for Payer: Cigna of CA PPO |
$22.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$25.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
| Rate for Payer: Networks By Design Commercial |
$19.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$25.34
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
