|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,587.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5,844.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,849.12
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,587.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5,844.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,849.12
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$3,451.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.00
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,546.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,513.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna of CA HMO |
$2,598.40
|
| Rate for Payer: Cigna of CA PPO |
$3,004.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,030.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,030.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,030.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,030.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.20 |
| Max. Negotiated Rate |
$3,902.35 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Cash Price |
$2,525.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,836.40
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,841.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,525.05
|
| Rate for Payer: Cash Price |
$2,525.05
|
| Rate for Payer: Cash Price |
$2,525.05
|
| Rate for Payer: Cigna of CA HMO |
$2,938.24
|
| Rate for Payer: Cigna of CA PPO |
$3,397.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,295.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,295.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,295.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,995.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,995.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,596.00
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,520.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,469.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,858.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,986.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,358.15
|
| Rate for Payer: Cash Price |
$6,590.10
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,387.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,387.40
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,991.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Cash Price |
$6,590.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$8,401.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,680.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,620.55
|
| Rate for Payer: Cash Price |
$4,620.55
|
| Rate for Payer: Cash Price |
$4,620.55
|
| Rate for Payer: Cigna of CA HMO |
$5,376.64
|
| Rate for Payer: Cigna of CA PPO |
$6,216.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,140.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,040.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,720.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,460.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,140.85
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,040.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,200.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$8,401.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,680.20 |
| Max. Negotiated Rate |
$7,140.85 |
| Rate for Payer: Adventist Health Commercial |
$1,680.20
|
| Rate for Payer: Cash Price |
$4,620.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,360.40
|
| Rate for Payer: Galaxy Health WC |
$7,140.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,040.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,200.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,200.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.24
|
| Rate for Payer: Multiplan Commercial |
$6,720.80
|
| Rate for Payer: Networks By Design Commercial |
$5,460.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,140.85
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$1,843.65 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,256.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.13
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$1,843.65 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,256.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.13
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$257.00
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.36 |
| Max. Negotiated Rate |
$436.90 |
| Rate for Payer: Adventist Health Commercial |
$210.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.71
|
| Rate for Payer: Blue Shield of California Commercial |
$379.33
|
| Rate for Payer: Blue Shield of California EPN |
$249.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$257.00
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
