|
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
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| 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: 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| 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
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
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
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
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 SMALL CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
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 SM TALL CLOSED
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
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
|
|
|
HC BOOT WALKER SM TALL CLOSED
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| 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: 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| 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
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
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 STANDARD CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
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 X-SM STNDRD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$189.35 |
| 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 |
$171.42
|
| 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 |
$189.35
|
| 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
|
|
|
HC BOOT WALKER X-SM STNDRD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| 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: 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| 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
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
IP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
OP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.10
|
| Rate for Payer: Blue Shield of California Commercial |
$27.15
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$28.44
|
| Rate for Payer: Cigna of CA PPO |
$32.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.00
|
| Rate for Payer: InnovAge PACE Commercial |
$22.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.11
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
| Rate for Payer: Riverside University Health System MISP |
$17.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$22.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.77
|
| Rate for Payer: Vantage Medical Group Senior |
$37.77
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$599.60 |
| Max. Negotiated Rate |
$2,698.20 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,199.20
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,142.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,855.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
|
|
HC BOTOX INJECTION
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$418.15 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$643.40 |
| Max. Negotiated Rate |
$2,895.30 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Cash Price |
$1,769.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,286.80
|
| Rate for Payer: Galaxy Health WC |
$2,734.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,895.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,145.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,225.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,991.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.40
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
| Rate for Payer: Networks By Design Commercial |
$2,091.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,734.45
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,557.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,889.34
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,769.35
|
| Rate for Payer: Cash Price |
$1,769.35
|
| Rate for Payer: Cash Price |
$1,769.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,573.60
|
| Rate for Payer: Cigna of CA HMO |
$2,058.88
|
| Rate for Payer: Cigna of CA PPO |
$2,380.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$2,734.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,895.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,145.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$2,091.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$2,734.45
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Blue Shield of California Commercial |
$156.92
|
| Rate for Payer: Blue Shield of California EPN |
$102.31
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: Central Health Plan Commercial |
$162.40
|
| Rate for Payer: Cigna of CA HMO |
$142.10
|
| Rate for Payer: Cigna of CA PPO |
$142.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.60
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$74.16
|
| Rate for Payer: United Healthcare HMO Rider |
$72.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.48
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Adventist Health Commercial |
$83.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.22
|
| Rate for Payer: Blue Shield of California Commercial |
$156.92
|
| Rate for Payer: Blue Shield of California EPN |
$102.31
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: Central Health Plan Commercial |
$162.40
|
| Rate for Payer: Cigna of CA HMO |
$142.10
|
| Rate for Payer: Cigna of CA PPO |
$142.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: InnovAge PACE Commercial |
$101.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.10
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: Networks By Design Commercial |
$101.50
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: Riverside University Health System MISP |
$81.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$74.16
|
| Rate for Payer: United Healthcare HMO Rider |
$72.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
IP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Adventist Health Commercial |
$35.97
|
| Rate for Payer: Blue Shield of California Commercial |
$139.01
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$98.91
|
| Rate for Payer: Central Health Plan Commercial |
$143.86
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Multiplan Commercial |
$134.87
|
| Rate for Payer: Networks By Design Commercial |
$116.89
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
OP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Adventist Health Commercial |
$73.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.61
|
| Rate for Payer: Blue Shield of California Commercial |
$139.01
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$98.91
|
| Rate for Payer: Cash Price |
$98.91
|
| Rate for Payer: Central Health Plan Commercial |
$143.86
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: InnovAge PACE Commercial |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.88
|
| Rate for Payer: Multiplan Commercial |
$134.87
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: Riverside University Health System MISP |
$71.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.86
|
| Rate for Payer: Vantage Medical Group Senior |
$152.86
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,582.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.69
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.04 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$839.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,202.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,582.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.69
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,023.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$839.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Riverside University Health System MISP |
$818.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
OP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Adventist Health Commercial |
$128.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.38
|
| Rate for Payer: Blue Shield of California EPN |
$157.38
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Central Health Plan Commercial |
$249.82
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.82
|
| Rate for Payer: InnovAge PACE Commercial |
$156.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.59
|
| Rate for Payer: Multiplan Commercial |
$234.20
|
| Rate for Payer: Networks By Design Commercial |
$156.13
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: Riverside University Health System MISP |
$124.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.43
|
| Rate for Payer: Vantage Medical Group Senior |
$265.43
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
IP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Adventist Health Commercial |
$62.45
|
| Rate for Payer: Blue Shield of California Commercial |
$241.38
|
| Rate for Payer: Blue Shield of California EPN |
$157.38
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Central Health Plan Commercial |
$249.82
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.45
|
| Rate for Payer: Multiplan Commercial |
$234.20
|
| Rate for Payer: Networks By Design Commercial |
$202.98
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
|
