|
HC BOOT WALKER LRG STANDARD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER LRG STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.18
|
| Rate for Payer: Blue Shield of California Commercial |
$120.01
|
| Rate for Payer: Blue Shield of California EPN |
$79.03
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.18
|
| Rate for Payer: Blue Shield of California Commercial |
$120.01
|
| Rate for Payer: Blue Shield of California EPN |
$79.03
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
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
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
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 SM TALL CLOSED
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.18
|
| Rate for Payer: Blue Shield of California Commercial |
$120.01
|
| Rate for Payer: Blue Shield of California EPN |
$79.03
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER SM TALL CLOSED
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
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 STANDARD CLOSED HEEL
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
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
|
|
|
HC BOOT WALKER X-SM STNDRD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$189.35 |
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.18
|
| Rate for Payer: Blue Shield of California Commercial |
$120.01
|
| Rate for Payer: Blue Shield of California EPN |
$79.03
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER X-SM STNDRD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
OP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$37.77 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.29
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$28.44
|
| Rate for Payer: Cigna of CA PPO |
$32.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.11
|
| Rate for Payer: Multiplan Commercial |
$35.55
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$22.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.77
|
| Rate for Payer: Vantage Medical Group Senior |
$37.77
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
IP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$37.77 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.67
|
| Rate for Payer: Multiplan Commercial |
$35.55
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
|
|
HC BOTOX INJECTION
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.42 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,398.40
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,777.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.48 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$324.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cigna of CA HMO |
$1,038.08
|
| Rate for Payer: Cigna of CA PPO |
$1,200.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,378.70
|
| Rate for Payer: Global Benefits Group Commercial |
$973.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,378.70
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$1,378.70 |
| Rate for Payer: Adventist Health Commercial |
$324.40
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.80
|
| Rate for Payer: EPIC Health Plan Senior |
$648.80
|
| Rate for Payer: Galaxy Health WC |
$1,378.70
|
| Rate for Payer: Global Benefits Group Commercial |
$973.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.28
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: Networks By Design Commercial |
$1,054.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,378.70
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
OP
|
$203.42
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.82
|
| Rate for Payer: Blue Shield of California Commercial |
$150.12
|
| Rate for Payer: Blue Shield of California EPN |
$98.86
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cigna of CA HMO |
$142.39
|
| Rate for Payer: Cigna of CA PPO |
$142.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.37
|
| Rate for Payer: EPIC Health Plan Senior |
$81.37
|
| Rate for Payer: Galaxy Health WC |
$172.91
|
| Rate for Payer: Global Benefits Group Commercial |
$122.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.39
|
| Rate for Payer: Multiplan Commercial |
$162.74
|
| Rate for Payer: Networks By Design Commercial |
$101.71
|
| Rate for Payer: Prime Health Services Commercial |
$172.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Other HMO |
$74.31
|
| Rate for Payer: United Healthcare HMO Rider |
$72.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.91
|
| Rate for Payer: Vantage Medical Group Senior |
$172.91
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
IP
|
$203.42
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cigna of CA HMO |
$142.39
|
| Rate for Payer: Cigna of CA PPO |
$142.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.37
|
| Rate for Payer: EPIC Health Plan Senior |
$81.37
|
| Rate for Payer: Galaxy Health WC |
$172.91
|
| Rate for Payer: Global Benefits Group Commercial |
$122.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.82
|
| Rate for Payer: Multiplan Commercial |
$162.74
|
| Rate for Payer: Networks By Design Commercial |
$101.71
|
| Rate for Payer: Prime Health Services Commercial |
$172.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Other HMO |
$74.31
|
| Rate for Payer: United Healthcare HMO Rider |
$72.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.62
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
OP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$152.86 |
| Rate for Payer: Adventist Health Commercial |
$73.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.16
|
| Rate for Payer: Blue Shield of California Commercial |
$132.71
|
| Rate for Payer: Blue Shield of California EPN |
$87.40
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.88
|
| Rate for Payer: Multiplan Commercial |
$143.86
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.86
|
| Rate for Payer: Vantage Medical Group Senior |
$152.86
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
IP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$143.86
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$1,739.95 |
| Rate for Payer: Adventist Health Commercial |
$839.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,510.69
|
| Rate for Payer: Blue Shield of California EPN |
$994.84
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
IP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.94
|
| Rate for Payer: Multiplan Commercial |
$249.82
|
| Rate for Payer: Networks By Design Commercial |
$156.13
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
|
