|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.18
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: InnovAge PACE Commercial |
$284.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: InnovAge PACE Commercial |
$284.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT 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 |
$10,988.97
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,416.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,843.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$9,240.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Adventist Health Commercial |
$2,843.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,988.97
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,416.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,843.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$9,240.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
OP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
915355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,230.59 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Adventist Health Commercial |
$5,828.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,818.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,662.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,349.06
|
| Rate for Payer: Blue Shield of California Commercial |
$10,988.97
|
| Rate for Payer: Blue Shield of California EPN |
$7,164.86
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,083.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,230.59
|
| Rate for Payer: InnovAge PACE Commercial |
$7,108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,828.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,951.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,951.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: Riverside University Health System MISP |
$5,686.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,529.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,083.60
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
OP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,230.59 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Adventist Health Commercial |
$5,828.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,818.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,662.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,349.06
|
| Rate for Payer: Blue Shield of California Commercial |
$10,988.97
|
| Rate for Payer: Blue Shield of California EPN |
$7,164.86
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,083.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,230.59
|
| Rate for Payer: InnovAge PACE Commercial |
$7,108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,568.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,799.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,828.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,951.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,951.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: Riverside University Health System MISP |
$5,686.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,529.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,335.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5,193.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5,080.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,655.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,083.60
|
|
|
HC FOOT 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 |
$641.92
|
| Rate for Payer: Blue Shield of California Commercial |
$844.89
|
| 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: 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: InnovAge PACE Commercial |
$546.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
915355972
|
|
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 |
$844.89
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| 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
|
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 |
$641.92
|
| Rate for Payer: Blue Shield of California Commercial |
$844.89
|
| 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: 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: InnovAge PACE Commercial |
$546.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$844.89
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| 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 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 |
$6,766.84
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,335.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,418.73
|
| 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 |
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 |
$5,141.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6,766.84
|
| 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: 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: InnovAge PACE Commercial |
$4,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,418.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,589.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,127.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$5,141.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6,766.84
|
| 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: 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: InnovAge PACE Commercial |
$4,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,418.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,589.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,127.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$6,766.84
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,335.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,418.73
|
| 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
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$517.16
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| 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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| 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 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: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| 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 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 |
$1,207.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| 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
|
|
