|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.62
|
| Rate for Payer: Blue Shield of California Commercial |
$82.42
|
| Rate for Payer: Blue Shield of California EPN |
$51.87
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Riverside University Health System MISP |
$52.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.66
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.96
|
| Rate for Payer: Blue Shield of California Commercial |
$264.66
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.96
|
| Rate for Payer: Blue Shield of California Commercial |
$264.66
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.66
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.47
|
| Rate for Payer: Blue Shield of California Commercial |
$691.74
|
| Rate for Payer: Blue Shield of California EPN |
$435.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: Cigna of CA HMO |
$702.72
|
| Rate for Payer: Cigna of CA PPO |
$812.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$697.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$658.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$658.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: EPIC Health Plan Senior |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$697.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$647.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.67
|
| Rate for Payer: Blue Shield of California Commercial |
$119.50
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Riverside University Health System MISP |
$59.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California Commercial |
$119.50
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.67
|
| Rate for Payer: Blue Shield of California Commercial |
$119.50
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Riverside University Health System MISP |
$59.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California Commercial |
$119.50
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$456.34
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.99
|
| Rate for Payer: Blue Shield of California Commercial |
$456.34
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.99
|
| Rate for Payer: Blue Shield of California Commercial |
$456.34
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$456.34
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
OP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
915355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,230.59 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Adventist Health Commercial |
$5,828.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,818.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,662.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,269.45
|
| Rate for Payer: Blue Shield of California Commercial |
$11,401.23
|
| Rate for Payer: Blue Shield of California EPN |
$7,164.86
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,083.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,083.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,230.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,828.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,951.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: Riverside University Health System MISP |
$5,686.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,529.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,083.60
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,401.23
|
| Rate for Payer: Blue Shield of California EPN |
$7,164.86
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,843.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$9,240.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
915355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,401.23
|
| Rate for Payer: Blue Shield of California EPN |
$7,164.86
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,027.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,387.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,843.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$9,240.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
|
