|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$143.50
|
| 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 |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| 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: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| 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: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC BOOT MULTIPODUS YOUTH
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$143.50
|
| 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 |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| 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: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| 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: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
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 |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$143.50
|
| 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 |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| 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: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| 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: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
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 |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$143.50
|
| 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 |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT ORTHOSIS FOOT ADULT MED
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
901603241
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| 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: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
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: 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 |
$227.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.94
|
| Rate for Payer: Blue Distinction Transplant |
$247.74
|
| Rate for Payer: Blue Shield of California Commercial |
$259.71
|
| Rate for Payer: Blue Shield of California EPN |
$201.91
|
| Rate for Payer: Cash Price |
$185.81
|
| 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 Media |
$350.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$309.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.52
|
| 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: 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
|
| 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 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: Cash Price |
$185.81
|
| Rate for Payer: Central Health Plan Commercial |
$330.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
OP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Distinction Transplant |
$161.87
|
| Rate for Payer: Blue Shield of California Commercial |
$202.34
|
| Rate for Payer: Blue Shield of California EPN |
$146.76
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.31
|
| Rate for Payer: Dignity Health Media |
$229.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$202.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.61
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: Riverside University Health System MISP |
$107.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.89
|
| Rate for Payer: United Healthcare All Other HMO |
$134.89
|
| Rate for Payer: United Healthcare HMO Rider |
$134.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.31
|
| Rate for Payer: Vantage Medical Group Senior |
$229.31
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
IP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.96 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Blue Shield of California EPN |
$144.06
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.96
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.87
|
| Rate for Payer: United Healthcare All Other HMO |
$99.49
|
| Rate for Payer: United Healthcare HMO Rider |
$97.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.03
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
OP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Distinction Transplant |
$161.87
|
| Rate for Payer: Blue Shield of California Commercial |
$202.34
|
| Rate for Payer: Blue Shield of California EPN |
$146.76
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.31
|
| Rate for Payer: Dignity Health Media |
$229.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$202.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.61
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: Riverside University Health System MISP |
$107.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.89
|
| Rate for Payer: United Healthcare All Other HMO |
$134.89
|
| Rate for Payer: United Healthcare HMO Rider |
$134.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.31
|
| Rate for Payer: Vantage Medical Group Senior |
$229.31
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
IP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.96 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Blue Shield of California EPN |
$144.06
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.96
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.87
|
| Rate for Payer: United Healthcare All Other HMO |
$99.49
|
| Rate for Payer: United Healthcare HMO Rider |
$97.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.03
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
IP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.96 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Blue Shield of California EPN |
$144.06
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.96
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.87
|
| Rate for Payer: United Healthcare All Other HMO |
$99.49
|
| Rate for Payer: United Healthcare HMO Rider |
$97.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.03
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
OP
|
$269.78
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Distinction Transplant |
$161.87
|
| Rate for Payer: Blue Shield of California Commercial |
$202.34
|
| Rate for Payer: Blue Shield of California EPN |
$146.76
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Central Health Plan Commercial |
$215.82
|
| Rate for Payer: Cigna of CA HMO |
$188.85
|
| Rate for Payer: Cigna of CA PPO |
$188.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.31
|
| Rate for Payer: Dignity Health Media |
$229.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.91
|
| Rate for Payer: Galaxy Health WC |
$229.31
|
| Rate for Payer: Global Benefits Group Commercial |
$161.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$202.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.61
|
| Rate for Payer: Multiplan Commercial |
$202.34
|
| Rate for Payer: Networks By Design Commercial |
$134.89
|
| Rate for Payer: Prime Health Services Commercial |
$229.31
|
| Rate for Payer: Riverside University Health System MISP |
$107.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.89
|
| Rate for Payer: United Healthcare All Other HMO |
$134.89
|
| Rate for Payer: United Healthcare HMO Rider |
$134.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.31
|
| Rate for Payer: Vantage Medical Group Senior |
$229.31
|
|
|
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: 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 |
$24.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Distinction Transplant |
$26.66
|
| Rate for Payer: Blue Shield of California Commercial |
$27.95
|
| Rate for Payer: Blue Shield of California EPN |
$21.73
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Media |
$37.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$33.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.55
|
| 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: 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
|
| 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 Medi-Cal |
$37.77
|
| Rate for Payer: Vantage Medical Group Senior |
$37.77
|
|
|
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: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 BOTOX INJECTION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,227.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,111.40 |
| Max. Negotiated Rate |
$5,001.30 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.80
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.40
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.25 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,459.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,945.60
|
| Rate for Payer: Cigna of CA PPO |
$1,799.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,188.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,824.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
OP
|
$173.53
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$156.18 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.52
|
| Rate for Payer: Blue Distinction Transplant |
$104.12
|
| Rate for Payer: Blue Shield of California Commercial |
$130.15
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$78.09
|
| Rate for Payer: Cash Price |
$78.09
|
| Rate for Payer: Central Health Plan Commercial |
$138.82
|
| Rate for Payer: Cigna of CA HMO |
$121.47
|
| Rate for Payer: Cigna of CA PPO |
$121.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.50
|
| Rate for Payer: Dignity Health Media |
$147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.41
|
| Rate for Payer: Galaxy Health WC |
$147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$104.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$130.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.15
|
| Rate for Payer: Multiplan Commercial |
$130.15
|
| Rate for Payer: Networks By Design Commercial |
$86.76
|
| Rate for Payer: Prime Health Services Commercial |
$147.50
|
| Rate for Payer: Riverside University Health System MISP |
$69.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.76
|
| Rate for Payer: United Healthcare All Other HMO |
$86.76
|
| Rate for Payer: United Healthcare HMO Rider |
$86.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$147.50
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
IP
|
$173.53
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$156.18 |
| Rate for Payer: Blue Shield of California EPN |
$92.67
|
| Rate for Payer: Cash Price |
$78.09
|
| Rate for Payer: Central Health Plan Commercial |
$138.82
|
| Rate for Payer: Cigna of CA HMO |
$121.47
|
| Rate for Payer: Cigna of CA PPO |
$121.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.41
|
| Rate for Payer: Galaxy Health WC |
$147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$104.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.71
|
| Rate for Payer: Multiplan Commercial |
$130.15
|
| Rate for Payer: Networks By Design Commercial |
$86.76
|
| Rate for Payer: Prime Health Services Commercial |
$147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.52
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$62.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.26
|
|
|
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: Blue Shield of California EPN |
$96.03
|
| Rate for Payer: Cash Price |
$80.92
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$35.97
|
| 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: United Healthcare All Other Commercial |
$67.90
|
| Rate for Payer: United Healthcare All Other HMO |
$66.32
|
| Rate for Payer: United Healthcare HMO Rider |
$64.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.34
|
|
