|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,783.80 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,387.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,608.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,069.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$29,060.39 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29,060.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,986.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,801.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,969.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,596.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,780.82
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,184.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,387.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,608.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,349.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,069.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,387.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,792.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$13,072.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,614.40 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Adventist Health Commercial |
$2,614.40
|
| Rate for Payer: Cash Price |
$5,882.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,457.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,228.80
|
| Rate for Payer: Galaxy Health WC |
$11,111.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,764.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,300.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,712.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,614.40
|
| Rate for Payer: Multiplan Commercial |
$9,804.00
|
| Rate for Payer: Networks By Design Commercial |
$8,496.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,111.20
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$13,072.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Adventist Health Commercial |
$2,614.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,882.40
|
| Rate for Payer: Cash Price |
$5,882.40
|
| Rate for Payer: Cash Price |
$5,882.40
|
| Rate for Payer: Cash Price |
$5,882.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,457.60
|
| Rate for Payer: Cigna of CA HMO |
$8,366.08
|
| Rate for Payer: Cigna of CA PPO |
$9,673.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$11,111.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,764.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,300.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,614.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$9,804.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,496.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$11,111.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,843.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,536.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,536.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,536.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.80
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.80
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.35 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,261.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Riverside University Health System MISP |
$867.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.35 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,261.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,377.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Riverside University Health System MISP |
$867.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.34 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$210.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.99
|
| Rate for Payer: Blue Shield of California Commercial |
$412.23
|
| Rate for Payer: Blue Shield of California EPN |
$259.06
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$257.00
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California Commercial |
$412.23
|
| Rate for Payer: Blue Shield of California EPN |
$259.06
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.52
|
| Rate for Payer: Blue Shield of California Commercial |
$810.02
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Riverside University Health System MISP |
$404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California Commercial |
$810.02
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California Commercial |
$810.02
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.52
|
| Rate for Payer: Blue Shield of California Commercial |
$810.02
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$595.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Riverside University Health System MISP |
$404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$692.93
|
| Rate for Payer: Blue Shield of California EPN |
$435.46
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$692.93
|
| Rate for Payer: Blue Shield of California EPN |
$435.46
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.96 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.59
|
| Rate for Payer: Blue Shield of California Commercial |
$692.93
|
| Rate for Payer: Blue Shield of California EPN |
$435.46
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.96 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.59
|
| Rate for Payer: Blue Shield of California Commercial |
$692.93
|
| Rate for Payer: Blue Shield of California EPN |
$435.46
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$308.56 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.90
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Riverside University Health System MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
915353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
