|
HC BOOT CAST PEDS MED
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.89
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.89
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST UNISEX ADULT LRG
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.53
|
| Rate for Payer: Blue Shield of California Commercial |
$63.79
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Cigna of CA HMO |
$64.40
|
| Rate for Payer: Cigna of CA PPO |
$74.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.43
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
| Rate for Payer: Riverside University Health System MISP |
$40.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Other HMO |
$50.31
|
| Rate for Payer: United Healthcare HMO Rider |
$50.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.53
|
| Rate for Payer: Vantage Medical Group Senior |
$85.53
|
|
|
HC BOOT CAST UNISEX ADULT LRG
|
Facility
|
IP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$90.56 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
|
|
HC BOOT CAST UNISEX ADULT MED
|
Facility
|
IP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$90.56 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
|
|
HC BOOT CAST UNISEX ADULT MED
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.53
|
| Rate for Payer: Blue Shield of California Commercial |
$63.79
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Cigna of CA HMO |
$64.40
|
| Rate for Payer: Cigna of CA PPO |
$74.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.43
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
| Rate for Payer: Riverside University Health System MISP |
$40.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Other HMO |
$50.31
|
| Rate for Payer: United Healthcare HMO Rider |
$50.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.53
|
| Rate for Payer: Vantage Medical Group Senior |
$85.53
|
|
|
HC BOOT CAST UNISEX ADULT X-LRG
|
Facility
|
IP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$90.56 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
|
|
HC BOOT CAST UNISEX ADULT X-LRG
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
901698870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Adventist Health Commercial |
$20.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.53
|
| Rate for Payer: Blue Shield of California Commercial |
$63.79
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| Rate for Payer: Cigna of CA HMO |
$64.40
|
| Rate for Payer: Cigna of CA PPO |
$74.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.25
|
| Rate for Payer: EPIC Health Plan Senior |
$40.25
|
| Rate for Payer: Galaxy Health WC |
$85.53
|
| Rate for Payer: Global Benefits Group Commercial |
$60.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.43
|
| Rate for Payer: Multiplan Commercial |
$75.47
|
| Rate for Payer: Networks By Design Commercial |
$65.40
|
| Rate for Payer: Prime Health Services Commercial |
$85.53
|
| Rate for Payer: Riverside University Health System MISP |
$40.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Other HMO |
$50.31
|
| Rate for Payer: United Healthcare HMO Rider |
$50.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.53
|
| Rate for Payer: Vantage Medical Group Senior |
$85.53
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$465.16
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$465.16
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$495.85 |
| Rate for Payer: Adventist Health Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California Commercial |
$441.85
|
| Rate for Payer: Blue Shield of California EPN |
$277.67
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Central Health Plan Commercial |
$440.75
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.19
|
| Rate for Payer: Multiplan Commercial |
$413.20
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$495.85 |
| Rate for Payer: Adventist Health Commercial |
$225.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.48
|
| Rate for Payer: Blue Shield of California Commercial |
$441.85
|
| Rate for Payer: Blue Shield of California EPN |
$277.67
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Central Health Plan Commercial |
$440.75
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$385.66
|
| Rate for Payer: Multiplan Commercial |
$413.20
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: Riverside University Health System MISP |
$220.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.30
|
| Rate for Payer: Vantage Medical Group Senior |
$468.30
|
|
|
HC BOOT MULTIPODUS YOUTH
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS YOUTH
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT ORTHOSIS FOOT ADULT LG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT ORTHOSIS FOOT ADULT LG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT ORTHOSIS FOOT ADULT MED
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603241
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT ORTHOSIS FOOT ADULT MED
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603241
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT REGULAR TRACTION
|
Facility
|
IP
|
$412.90
|
|
| Hospital Charge Code |
901698331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$371.61 |
| Rate for Payer: Adventist Health Commercial |
$82.58
|
| Rate for Payer: Cash Price |
$185.80
|
| Rate for Payer: Central Health Plan Commercial |
$330.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.16
|
| Rate for Payer: EPIC Health Plan Senior |
$165.16
|
| Rate for Payer: Galaxy Health WC |
$350.96
|
| Rate for Payer: Global Benefits Group Commercial |
$247.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.58
|
| Rate for Payer: Multiplan Commercial |
$309.68
|
| Rate for Payer: Networks By Design Commercial |
$268.38
|
| Rate for Payer: Prime Health Services Commercial |
$350.96
|
|
