|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
IP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
915355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,750.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| 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: 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
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
OP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
915355981
|
|
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 LIMITED 2 VIEWS
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.06
|
| 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 |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$252.60
|
| Rate for Payer: Blue Shield of California Commercial |
$382.80
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO |
$384.00
|
| Rate for Payer: Cigna of CA PPO |
$444.00
|
| 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 |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| 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 |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| 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 LIMITED 2 VIEWS
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$354.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.78 |
| Max. Negotiated Rate |
$1,327.70 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.48
|
| Rate for Payer: Blue Shield of California Commercial |
$791.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,201.18
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
915355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
915355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.78 |
| Max. Negotiated Rate |
$1,327.70 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.48
|
| Rate for Payer: Blue Shield of California Commercial |
$791.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,201.18
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.87
|
| Rate for Payer: Blue Shield of California Commercial |
$619.81
|
| Rate for Payer: Blue Shield of California Commercial |
$408.64
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$479.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.87
|
| Rate for Payer: Blue Shield of California Commercial |
$619.81
|
| Rate for Payer: Blue Shield of California Commercial |
$408.64
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$479.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
905355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$346.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$634.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.08
|
| Rate for Payer: Blue Shield of California Commercial |
$650.57
|
| Rate for Payer: Blue Shield of California Commercial |
$428.92
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$719.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$592.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$592.20
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
915355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
915355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$346.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$634.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.08
|
| Rate for Payer: Blue Shield of California Commercial |
$650.57
|
| Rate for Payer: Blue Shield of California Commercial |
$428.92
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$719.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$592.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$592.20
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
905355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
HC FO PIP/DIP W/O JOINT/SPRING
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
905353927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.58
|
| Rate for Payer: Blue Shield of California Commercial |
$55.37
|
| Rate for Payer: Blue Shield of California Commercial |
$36.50
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC FO PIP/DIP W/O JOINT/SPRING
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
905353927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
905353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$92.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.19
|
| Rate for Payer: Blue Shield of California Commercial |
$114.08
|
| Rate for Payer: Blue Shield of California Commercial |
$173.03
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$112.50
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
915353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
915353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$92.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.19
|
| Rate for Payer: Blue Shield of California Commercial |
$114.08
|
| Rate for Payer: Blue Shield of California Commercial |
$173.03
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$112.50
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
