|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cigna of CA HMO |
$2,938.24
|
| Rate for Payer: Cigna of CA PPO |
$3,397.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,213.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,915.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,295.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,295.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,295.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.20 |
| Max. Negotiated Rate |
$3,902.35 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,213.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,836.40
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,915.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,708.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,793.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,596.00
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,533.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,354.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,793.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,533.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,995.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,995.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,387.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,608.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,069.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$32,927.57 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,927.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,986.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,688.85
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,184.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,387.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,608.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,349.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,069.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,387.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,387.40
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$8,401.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,680.20 |
| Max. Negotiated Rate |
$7,140.85 |
| Rate for Payer: Adventist Health Commercial |
$1,680.20
|
| Rate for Payer: Cash Price |
$3,780.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,880.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,360.40
|
| Rate for Payer: Galaxy Health WC |
$7,140.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,040.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,956.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.24
|
| Rate for Payer: Multiplan Commercial |
$6,720.80
|
| Rate for Payer: Networks By Design Commercial |
$5,460.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,140.85
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$8,401.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,680.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,780.45
|
| Rate for Payer: Cash Price |
$3,780.45
|
| Rate for Payer: Cash Price |
$3,780.45
|
| Rate for Payer: Cigna of CA HMO |
$5,376.64
|
| Rate for Payer: Cigna of CA PPO |
$6,216.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,880.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,140.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,040.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,720.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,460.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,140.85
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,040.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,200.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$1,843.65 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,312.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,667.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.68
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$1,843.65 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,312.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,667.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.68
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.56
|
| Rate for Payer: Multiplan Commercial |
$1,735.20
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.36 |
| Max. Negotiated Rate |
$436.90 |
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
| Rate for Payer: Adventist Health Commercial |
$210.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.12
|
| Rate for Payer: Blue Shield of California Commercial |
$395.27
|
| Rate for Payer: Blue Shield of California Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$257.00
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$858.50 |
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.35
|
| Rate for Payer: Blue Shield of California Commercial |
$776.69
|
| Rate for Payer: Blue Shield of California Commercial |
$512.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$858.50 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.35
|
| Rate for Payer: Blue Shield of California Commercial |
$776.69
|
| Rate for Payer: Blue Shield of California Commercial |
$512.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.98
|
| Rate for Payer: Blue Shield of California Commercial |
$664.42
|
| Rate for Payer: Blue Shield of California Commercial |
$438.05
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.98
|
| Rate for Payer: Blue Shield of California Commercial |
$664.42
|
| Rate for Payer: Blue Shield of California Commercial |
$438.05
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$308.56 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.22
|
| Rate for Payer: Blue Shield of California Commercial |
$206.09
|
| Rate for Payer: Blue Shield of California Commercial |
$135.88
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC FX OX ADD SOCK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
