|
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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$227.50
|
| 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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$227.50
|
| 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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$264.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$262.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$262.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.61
|
| 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 |
$108.68
|
| Rate for Payer: Blue Shield of California Commercial |
$91.03
|
| Rate for Payer: Blue Shield of California Commercial |
$138.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 |
$116.71
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$105.70
|
| 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 |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$125.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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
|
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 |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$125.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$14,109.00 |
| 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: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$105.70
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 |
$116.71
|
| 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 |
$108.68
|
| Rate for Payer: Blue Shield of California Commercial |
$91.03
|
| Rate for Payer: Blue Shield of California Commercial |
$138.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$125.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$105.70
|
| 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
|
IP
|
$179.55
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 |
$116.71
|
| 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 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 |
$108.68
|
| Rate for Payer: Blue Shield of California Commercial |
$91.03
|
| Rate for Payer: Blue Shield of California Commercial |
$138.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.93
|
| 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 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: 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 |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$125.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 |
$105.70
|
| 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 |
$28.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.22
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.33
|
| 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 INJECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,098.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,398.40
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,243.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
