|
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 |
$55.34
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| 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 Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| 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 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 |
$61.11
|
| 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 |
$59.09
|
| Rate for Payer: Blue Shield of California Commercial |
$61.48
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$55.34
|
| Rate for Payer: Cash Price |
$55.34
|
| 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: 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: InnovAge PACE Commercial |
$50.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.43
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$61.11
|
| 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 |
$59.09
|
| Rate for Payer: Blue Shield of California Commercial |
$61.48
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$55.34
|
| Rate for Payer: Cash Price |
$55.34
|
| 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: 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: InnovAge PACE Commercial |
$50.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.43
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$55.34
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| 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 Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| 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
|
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 |
$55.34
|
| Rate for Payer: Central Health Plan Commercial |
$80.50
|
| 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 Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| 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 |
$61.11
|
| 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 |
$59.09
|
| Rate for Payer: Blue Shield of California Commercial |
$61.48
|
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$55.34
|
| Rate for Payer: Cash Price |
$55.34
|
| 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: 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: InnovAge PACE Commercial |
$50.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.43
|
| Rate for Payer: Molina Healthcare of CA 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 |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| 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 |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: 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: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
$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 |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$425.88
|
| Rate for Payer: Blue Shield of California EPN |
$277.67
|
| Rate for Payer: Cash Price |
$303.02
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.03
|
| 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
|
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 |
$323.57
|
| Rate for Payer: Blue Shield of California Commercial |
$425.88
|
| Rate for Payer: Blue Shield of California EPN |
$277.67
|
| Rate for Payer: Cash Price |
$303.02
|
| Rate for Payer: Cash Price |
$303.02
|
| 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: 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: InnovAge PACE Commercial |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.66
|
| Rate for Payer: Molina Healthcare of CA 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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
|
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 |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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 REGULAR TRACTION
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$250.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.50
|
| Rate for Payer: Blue Shield of California Commercial |
$252.28
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Central Health Plan Commercial |
$330.32
|
| Rate for Payer: Cigna of CA HMO |
$264.26
|
| Rate for Payer: Cigna of CA PPO |
$305.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.96
|
| 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: InnovAge PACE Commercial |
$206.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.03
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$165.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.45
|
| Rate for Payer: United Healthcare All Other HMO |
$206.45
|
| Rate for Payer: United Healthcare HMO Rider |
$206.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.96
|
| Rate for Payer: Vantage Medical Group Senior |
$350.96
|
|
|
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 |
$227.10
|
| Rate for Payer: Central Health Plan Commercial |
$330.32
|
| 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 Permanente of CA Commercial/Self Funded |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.59
|
| 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
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Adventist Health Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California Commercial |
$138.47
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$98.52
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$116.43
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Adventist Health Commercial |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$138.47
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$98.52
|
| Rate for Payer: Cash Price |
$98.52
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: InnovAge PACE Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.39
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$89.56
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: Riverside University Health System MISP |
$71.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.26
|
| Rate for Payer: Vantage Medical Group Senior |
$152.26
|
|
|
HC BOOT WALKER LRG STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.50
|
| Rate for Payer: Blue Shield of California Commercial |
$125.70
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.79
|
| Rate for Payer: InnovAge PACE Commercial |
$81.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
