|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.07
|
| Rate for Payer: Blue Distinction Transplant |
$226.55
|
| Rate for Payer: Blue Shield of California Commercial |
$237.50
|
| Rate for Payer: Blue Shield of California EPN |
$184.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Media |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$283.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.52
|
| Rate for Payer: Blue Distinction Transplant |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.83
|
| Rate for Payer: Blue Shield of California EPN |
$132.03
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Media |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$202.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
905353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$99.00 |
| 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 |
$60.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.99
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$82.50
|
| Rate for Payer: Blue Shield of California EPN |
$59.84
|
| 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 Media |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| 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 |
$55.00
|
| Rate for Payer: United Healthcare All Other HMO |
$55.00
|
| Rate for Payer: United Healthcare HMO Rider |
$55.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
905353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Blue Shield of California EPN |
$58.74
|
| 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: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| 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 |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.54
|
| Rate for Payer: United Healthcare All Other HMO |
$40.57
|
| Rate for Payer: United Healthcare HMO Rider |
$39.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.30
|
|
|
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: Blue Shield of California EPN |
$57.14
|
| 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: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| 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 |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.46
|
| Rate for Payer: United Healthcare HMO Rider |
$38.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.31
|
|
|
HC SHOE HIGHTOP CHILD
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L3206
|
| Hospital Charge Code |
905353206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$96.30 |
| 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 |
$58.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.22
|
| Rate for Payer: Blue Distinction Transplant |
$64.20
|
| Rate for Payer: Blue Shield of California Commercial |
$80.25
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| 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 Media |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$80.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| 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 |
$53.50
|
| Rate for Payer: United Healthcare All Other HMO |
$53.50
|
| Rate for Payer: United Healthcare HMO Rider |
$53.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC SHOE HIGHTOP INFANT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT L3204
|
| Hospital Charge Code |
905353204
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.95 |
| Max. Negotiated Rate |
$87.30 |
| 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 |
$53.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.31
|
| Rate for Payer: Blue Distinction Transplant |
$58.20
|
| Rate for Payer: Blue Shield of California Commercial |
$72.75
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| 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 Media |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$72.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.77
|
| 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 |
$48.50
|
| Rate for Payer: United Healthcare All Other HMO |
$48.50
|
| Rate for Payer: United Healthcare HMO Rider |
$48.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.50
|
| 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: Blue Shield of California EPN |
$51.80
|
| 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: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| 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 |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.63
|
| Rate for Payer: United Healthcare All Other HMO |
$35.77
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.01
|
|
|
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: Blue Shield of California EPN |
$57.14
|
| 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: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| 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 |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.46
|
| Rate for Payer: United Healthcare HMO Rider |
$38.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.31
|
|
|
HC SHOE HIGHTOP JUNIOR
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L3207
|
| Hospital Charge Code |
905353207
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$96.30 |
| 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 |
$58.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.22
|
| Rate for Payer: Blue Distinction Transplant |
$64.20
|
| Rate for Payer: Blue Shield of California Commercial |
$80.25
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| 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 Media |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$80.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| 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 |
$53.50
|
| Rate for Payer: United Healthcare All Other HMO |
$53.50
|
| Rate for Payer: United Healthcare HMO Rider |
$53.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC SHOE POST-OP FEMALE LARGE
|
Facility
|
OP
|
$37.39
|
|
| Hospital Charge Code |
901606726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.09
|
| Rate for Payer: Blue Distinction Transplant |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.28
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: Cigna of CA HMO |
$23.93
|
| Rate for Payer: Cigna of CA PPO |
$27.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.78
|
| Rate for Payer: Dignity Health Media |
$31.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.70
|
| Rate for Payer: United Healthcare All Other HMO |
$18.70
|
| Rate for Payer: United Healthcare HMO Rider |
$18.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.78
|
| Rate for Payer: Vantage Medical Group Senior |
$31.78
|
|
|
HC SHOE POST-OP FEMALE LARGE
|
Facility
|
IP
|
$37.39
|
|
| Hospital Charge Code |
901606726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
|
|
HC SHOE POST-OP FEMALE MEDIUM
|
Facility
|
OP
|
$37.39
|
|
| Hospital Charge Code |
901606725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.09
|
| Rate for Payer: Blue Distinction Transplant |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.28
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: Cigna of CA HMO |
$23.93
|
| Rate for Payer: Cigna of CA PPO |
$27.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.78
|
| Rate for Payer: Dignity Health Media |
$31.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.70
|
| Rate for Payer: United Healthcare All Other HMO |
$18.70
|
| Rate for Payer: United Healthcare HMO Rider |
$18.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.78
|
| Rate for Payer: Vantage Medical Group Senior |
$31.78
|
|
|
HC SHOE POST-OP FEMALE MEDIUM
|
Facility
|
IP
|
$37.39
|
|
| Hospital Charge Code |
901606725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
|
|
HC SHOE POST-OP FEMALE SMALL
|
Facility
|
IP
|
$37.39
|
|
| Hospital Charge Code |
901606724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
|
|
HC SHOE POST-OP FEMALE SMALL
|
Facility
|
OP
|
$39.44
|
|
| Hospital Charge Code |
901698579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.30
|
| Rate for Payer: Blue Distinction Transplant |
$23.66
|
| Rate for Payer: Blue Shield of California Commercial |
$24.81
|
| Rate for Payer: Blue Shield of California EPN |
$19.29
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: Cigna of CA HMO |
$25.24
|
| Rate for Payer: Cigna of CA PPO |
$29.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.52
|
| Rate for Payer: Dignity Health Media |
$33.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
| Rate for Payer: Riverside University Health System MISP |
$15.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.72
|
| Rate for Payer: United Healthcare All Other HMO |
$19.72
|
| Rate for Payer: United Healthcare HMO Rider |
$19.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.52
|
| Rate for Payer: Vantage Medical Group Senior |
$33.52
|
|
|
HC SHOE POST-OP FEMALE SMALL
|
Facility
|
OP
|
$37.39
|
|
| Hospital Charge Code |
901606724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.09
|
| Rate for Payer: Blue Distinction Transplant |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.28
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: Cigna of CA HMO |
$23.93
|
| Rate for Payer: Cigna of CA PPO |
$27.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.78
|
| Rate for Payer: Dignity Health Media |
$31.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.70
|
| Rate for Payer: United Healthcare All Other HMO |
$18.70
|
| Rate for Payer: United Healthcare HMO Rider |
$18.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.78
|
| Rate for Payer: Vantage Medical Group Senior |
$31.78
|
|
|
HC SHOE POST-OP FEMALE SMALL
|
Facility
|
IP
|
$39.44
|
|
| Hospital Charge Code |
901698579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
|
|
HC SHOE POST-OP MALE LARGE
|
Facility
|
IP
|
$13.20
|
|
| Hospital Charge Code |
901606729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SHOE POST-OP MALE LARGE
|
Facility
|
OP
|
$13.20
|
|
| Hospital Charge Code |
901606729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.80
|
| Rate for Payer: Blue Distinction Transplant |
$7.92
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Media |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SHOE POST-OP MALE MEDIUM
|
Facility
|
OP
|
$37.39
|
|
| Hospital Charge Code |
901606728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.09
|
| Rate for Payer: Blue Distinction Transplant |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.28
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: Cigna of CA HMO |
$23.93
|
| Rate for Payer: Cigna of CA PPO |
$27.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.78
|
| Rate for Payer: Dignity Health Media |
$31.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.70
|
| Rate for Payer: United Healthcare All Other HMO |
$18.70
|
| Rate for Payer: United Healthcare HMO Rider |
$18.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.78
|
| Rate for Payer: Vantage Medical Group Senior |
$31.78
|
|
|
HC SHOE POST-OP MALE MEDIUM
|
Facility
|
IP
|
$37.39
|
|
| Hospital Charge Code |
901606728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
|
|
HC SHOE POST-OP MALE SMALL
|
Facility
|
IP
|
$37.39
|
|
| Hospital Charge Code |
901606727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
|
|
HC SHOE POST-OP MALE SMALL
|
Facility
|
OP
|
$37.39
|
|
| Hospital Charge Code |
901606727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.09
|
| Rate for Payer: Blue Distinction Transplant |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.28
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Central Health Plan Commercial |
$29.91
|
| Rate for Payer: Cigna of CA HMO |
$23.93
|
| Rate for Payer: Cigna of CA PPO |
$27.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.78
|
| Rate for Payer: Dignity Health Media |
$31.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$31.78
|
| Rate for Payer: Global Benefits Group Commercial |
$22.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Commercial |
$31.78
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.70
|
| Rate for Payer: United Healthcare All Other HMO |
$18.70
|
| Rate for Payer: United Healthcare HMO Rider |
$18.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.78
|
| Rate for Payer: Vantage Medical Group Senior |
$31.78
|
|
