|
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 |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 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 |
$168.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.63
|
| Rate for Payer: Blue Shield of California Commercial |
$325.43
|
| Rate for Payer: Blue Shield of California Commercial |
$493.17
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$347.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| 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 |
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 |
$90.19
|
| Rate for Payer: Blue Shield of California Commercial |
$75.54
|
| Rate for Payer: Blue Shield of California Commercial |
$114.58
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| 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 |
$96.85
|
| 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 |
$90.19
|
| Rate for Payer: Blue Shield of California Commercial |
$75.54
|
| Rate for Payer: Blue Shield of California Commercial |
$114.58
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| 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 |
$1,359.15
|
| 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
|
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 |
$1,265.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,060.14
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$558.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| 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 |
$1,359.15
|
| 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
|
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 |
$1,265.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,060.14
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$558.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| 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 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 |
$344.42
|
| Rate for Payer: Blue Shield of California Commercial |
$437.56
|
| Rate for Payer: Blue Shield of California Commercial |
$288.48
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| 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 |
$369.85
|
| 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
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| 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 |
$369.85
|
| 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 |
$344.42
|
| Rate for Payer: Blue Shield of California Commercial |
$437.56
|
| Rate for Payer: Blue Shield of California Commercial |
$288.48
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| 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
|
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 |
$8,604.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,207.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10,932.10
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,155.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| 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
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
915355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| 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 |
$9,240.40
|
| 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 |
915355980
|
|
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 |
$8,604.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,207.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10,932.10
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,155.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| 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 |
$9,240.40
|
| 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 FLEXIBLE KEEL SAFE/STEN
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
915355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.32 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$448.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$661.59
|
| Rate for Payer: Blue Shield of California Commercial |
$840.52
|
| Rate for Payer: Blue Shield of California Commercial |
$554.15
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$351.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
915355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.32 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$448.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$661.59
|
| Rate for Payer: Blue Shield of California Commercial |
$840.52
|
| Rate for Payer: Blue Shield of California Commercial |
$554.15
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$351.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
OP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,100.96 |
| Max. Negotiated Rate |
$7,440.90 |
| Rate for Payer: Adventist Health Commercial |
$3,589.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,814.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,298.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,731.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4,438.28
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,440.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,440.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,449.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,769.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,127.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,127.80
|
| Rate for Payer: Multiplan Commercial |
$7,003.20
|
| Rate for Payer: Networks By Design Commercial |
$4,377.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,440.90
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
IP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,750.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.96
|
| Rate for Payer: Multiplan Commercial |
$7,003.20
|
| Rate for Payer: Networks By Design Commercial |
$5,690.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
|
