|
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
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.96 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$448.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.80
|
| Rate for Payer: Blue Shield of California Commercial |
$876.59
|
| Rate for Payer: Blue Shield of California EPN |
$550.87
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Riverside University Health System MISP |
$437.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Blue Shield of California Commercial |
$876.59
|
| Rate for Payer: Blue Shield of California EPN |
$550.87
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
915355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Blue Shield of California Commercial |
$876.59
|
| Rate for Payer: Blue Shield of California EPN |
$550.87
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
915355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.96 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$448.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.80
|
| Rate for Payer: Blue Shield of California Commercial |
$876.59
|
| Rate for Payer: Blue Shield of California EPN |
$550.87
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$765.10
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Riverside University Health System MISP |
$437.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.20
|
| Rate for Payer: United Healthcare All Other HMO |
$399.27
|
| Rate for Payer: United Healthcare HMO Rider |
$390.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
IP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,750.80 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Adventist Health Commercial |
$1,750.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,020.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,412.02
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.80
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$5,690.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
OP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
915355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,507.45 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Adventist Health Commercial |
$3,589.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,814.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,092.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,020.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,412.02
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,440.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,440.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,507.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,769.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,589.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,127.80
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$4,377.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: Riverside University Health System MISP |
$3,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,440.90
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
OP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,507.45 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Adventist Health Commercial |
$3,589.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,814.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,092.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,020.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,412.02
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,440.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,440.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,507.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,769.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,589.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,127.80
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$4,377.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: Riverside University Health System MISP |
$3,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,440.90
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
IP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
915355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,750.80 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Adventist Health Commercial |
$1,750.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,020.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,412.02
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,558.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,164.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.80
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$5,690.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,197.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3,128.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,866.93
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$596.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.49
|
| 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 |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$536.76
|
| Rate for Payer: Blue Shield of California EPN |
$338.24
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| 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 |
$596.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| 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 |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| 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 MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
915355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$908.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.72
|
| Rate for Payer: Blue Shield of California EPN |
$787.25
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
915355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.72
|
| Rate for Payer: Blue Shield of California EPN |
$787.25
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$908.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.72
|
| Rate for Payer: Blue Shield of California EPN |
$787.25
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.72
|
| Rate for Payer: Blue Shield of California EPN |
$787.25
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$991.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$921.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$646.41
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$646.41
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$468.85
|
| Rate for Payer: Blue Shield of California Commercial |
$646.41
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$490.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$468.85
|
| Rate for Payer: Blue Shield of California Commercial |
$646.41
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$490.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.07
|
| Rate for Payer: Blue Shield of California Commercial |
$128.32
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$128.32
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.07
|
| Rate for Payer: Blue Shield of California Commercial |
$128.32
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$128.32
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
905355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Blue Shield of California Commercial |
$678.49
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
915355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Blue Shield of California Commercial |
$678.49
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
