|
HC BOOT CAST PEDS LG
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.62
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.62
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS STNDRD
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692803
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC BOOT CAST PEDS STNDRD
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692803
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.94
|
| Rate for Payer: Blue Shield of California Commercial |
$428.04
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$110.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.23
|
| Rate for Payer: Multiplan Commercial |
$440.75
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.23 |
| Max. Negotiated Rate |
$468.30 |
| Rate for Payer: Adventist Health Commercial |
$225.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.10
|
| Rate for Payer: Blue Shield of California Commercial |
$406.59
|
| Rate for Payer: Blue Shield of California EPN |
$267.76
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.66
|
| Rate for Payer: Multiplan Commercial |
$440.75
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.30
|
| Rate for Payer: Vantage Medical Group Senior |
$468.30
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS YOUTH
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS YOUTH
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT ORTHOSIS FOOT ADULT LG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT ORTHOSIS FOOT ADULT LG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT ORTHOSIS FOOT ADULT MED
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603241
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT ORTHOSIS FOOT ADULT MED
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603241
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT REGULAR TRACTION
|
Facility
|
OP
|
$412.90
|
|
| Hospital Charge Code |
901698331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$350.96 |
| Rate for Payer: Adventist Health Commercial |
$82.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.56
|
| Rate for Payer: Cash Price |
$185.80
|
| Rate for Payer: Cigna of CA HMO |
$264.26
|
| Rate for Payer: Cigna of CA PPO |
$305.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.16
|
| Rate for Payer: EPIC Health Plan Senior |
$165.16
|
| Rate for Payer: Galaxy Health WC |
$350.96
|
| Rate for Payer: Global Benefits Group Commercial |
$247.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.03
|
| Rate for Payer: Multiplan Commercial |
$330.32
|
| Rate for Payer: Networks By Design Commercial |
$268.38
|
| Rate for Payer: Prime Health Services Commercial |
$350.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.45
|
| Rate for Payer: United Healthcare All Other HMO |
$206.45
|
| Rate for Payer: United Healthcare HMO Rider |
$206.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.96
|
| Rate for Payer: Vantage Medical Group Senior |
$350.96
|
|
|
HC BOOT REGULAR TRACTION
|
Facility
|
IP
|
$412.90
|
|
| Hospital Charge Code |
901698331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$350.96 |
| Rate for Payer: Adventist Health Commercial |
$82.58
|
| Rate for Payer: Cash Price |
$185.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.16
|
| Rate for Payer: EPIC Health Plan Senior |
$165.16
|
| Rate for Payer: Galaxy Health WC |
$350.96
|
| Rate for Payer: Global Benefits Group Commercial |
$247.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.10
|
| Rate for Payer: Multiplan Commercial |
$330.32
|
| Rate for Payer: Networks By Design Commercial |
$268.38
|
| Rate for Payer: Prime Health Services Commercial |
$350.96
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Adventist Health Commercial |
$73.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.51
|
| Rate for Payer: Blue Shield of California EPN |
$87.26
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$125.69
|
| Rate for Payer: Cigna of CA PPO |
$125.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.82
|
| Rate for Payer: EPIC Health Plan Senior |
$71.82
|
| Rate for Payer: Galaxy Health WC |
$152.62
|
| Rate for Payer: Global Benefits Group Commercial |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.69
|
| Rate for Payer: Multiplan Commercial |
$143.64
|
| Rate for Payer: Networks By Design Commercial |
$89.78
|
| Rate for Payer: Prime Health Services Commercial |
$152.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.39
|
| Rate for Payer: United Healthcare All Other HMO |
$65.59
|
| Rate for Payer: United Healthcare HMO Rider |
$64.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.62
|
| Rate for Payer: Vantage Medical Group Senior |
$152.62
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$125.69
|
| Rate for Payer: Cigna of CA PPO |
$125.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.82
|
| Rate for Payer: EPIC Health Plan Senior |
$71.82
|
| Rate for Payer: Galaxy Health WC |
$152.62
|
| Rate for Payer: Global Benefits Group Commercial |
$107.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.09
|
| Rate for Payer: Multiplan Commercial |
$143.64
|
| Rate for Payer: Networks By Design Commercial |
$89.78
|
| Rate for Payer: Prime Health Services Commercial |
$152.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.39
|
| Rate for Payer: United Healthcare All Other HMO |
$65.59
|
| Rate for Payer: United Healthcare HMO Rider |
$64.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.80
|
|
