|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,275.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.55 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,492.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,392.30
|
| Rate for Payer: Blue Shield of California EPN |
$919.10
|
| Rate for Payer: Cash Price |
$1,251.25
|
| Rate for Payer: Cash Price |
$1,251.25
|
| Rate for Payer: Cigna of CA HMO |
$1,456.00
|
| Rate for Payer: Cigna of CA PPO |
$1,683.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$1,933.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$1,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,478.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,933.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,365.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.14
|
| Rate for Payer: Blue Shield of California Commercial |
$243.54
|
| Rate for Payer: Blue Shield of California EPN |
$160.38
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.14
|
| Rate for Payer: Blue Shield of California Commercial |
$243.54
|
| Rate for Payer: Blue Shield of California EPN |
$160.38
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$425.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.88
|
| Rate for Payer: Blue Shield of California Commercial |
$473.08
|
| Rate for Payer: Blue Shield of California EPN |
$312.29
|
| Rate for Payer: Cash Price |
$425.15
|
| Rate for Payer: Cash Price |
$425.15
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.30
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$72.41
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.30
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$72.41
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,211.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.23
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$558.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,211.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.23
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$558.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.57 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.56
|
| Rate for Payer: Blue Shield of California Commercial |
$419.92
|
| Rate for Payer: Blue Shield of California EPN |
$276.53
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.57 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.56
|
| Rate for Payer: Blue Shield of California Commercial |
$419.92
|
| Rate for Payer: Blue Shield of California EPN |
$276.53
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,818.80
|
| Rate for Payer: Cash Price |
$7,818.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,416.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.84
|
| Rate for Payer: Multiplan Commercial |
$11,372.80
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
OP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,155.46 |
| Max. Negotiated Rate |
$12,083.60 |
| Rate for Payer: Adventist Health Commercial |
$5,828.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,818.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,662.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,233.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10,491.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,908.98
|
| Rate for Payer: Cash Price |
$7,818.80
|
| Rate for Payer: Cash Price |
$7,818.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,083.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,155.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,951.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,951.20
|
| Rate for Payer: Multiplan Commercial |
$11,372.80
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,529.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,083.60
|
|
