|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
915355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.36
|
| 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: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.92
|
| Rate for Payer: InnovAge PACE Commercial |
$781.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$640.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.36
|
| 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: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.92
|
| Rate for Payer: InnovAge PACE Commercial |
$781.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$781.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.22
|
| Rate for Payer: United Healthcare All Other HMO |
$570.60
|
| Rate for Payer: United Healthcare HMO Rider |
$558.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.36
|
| Rate for Payer: Blue Shield of California Commercial |
$623.04
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$490.73
|
| Rate for Payer: InnovAge PACE Commercial |
$403.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$623.04
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
905352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$330.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.36
|
| Rate for Payer: Blue Shield of California Commercial |
$623.04
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$490.73
|
| Rate for Payer: InnovAge PACE Commercial |
$403.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC FOOT PLATE MOLDED TO PT ADDITION LE
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT L2250
|
| Hospital Charge Code |
915352250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$623.04
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.97
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.27
|
| Rate for Payer: InnovAge PACE Commercial |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
915353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.97
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.27
|
| Rate for Payer: InnovAge PACE Commercial |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Riverside University Health System MISP |
$64.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC FOOT ROTATION DEVICE INC SHOES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L3140
|
| Hospital Charge Code |
905353140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.68
|
| Rate for Payer: Blue Shield of California EPN |
$80.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
915355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$346.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$634.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.86
|
| Rate for Payer: Blue Shield of California Commercial |
$653.96
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.34
|
| Rate for Payer: InnovAge PACE Commercial |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$592.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$592.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Riverside University Health System MISP |
$338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
905355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.96
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
915355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.96
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
HC FOOT SINGLE AXIS ANKLE FOOT
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT L5974
|
| Hospital Charge Code |
905355974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Adventist Health Commercial |
$346.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$634.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.86
|
| Rate for Payer: Blue Shield of California Commercial |
$653.96
|
| Rate for Payer: Blue Shield of California EPN |
$426.38
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.34
|
| Rate for Payer: InnovAge PACE Commercial |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$592.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$592.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Riverside University Health System MISP |
$338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC FO PIP/DIP W/JOINT SPRING
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FO PIP/DIP W/JOINT SPRING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FO PIP DIP WO JOINT SPRING
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
903203927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
|
|
HC FO PIP DIP WO JOINT SPRING
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
903203927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.84
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC FO PIP/DIP W/O JOINT/SPRING
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
905353927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
|
|
HC FO PIP/DIP W/O JOINT/SPRING
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
905353927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.84
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
915353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$173.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.40
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
905353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$92.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.14
|
| Rate for Payer: Blue Shield of California Commercial |
$173.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.40
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: InnovAge PACE Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$112.50
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
905353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$173.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.40
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
|
|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
915353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$92.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.14
|
| Rate for Payer: Blue Shield of California Commercial |
$173.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.40
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: InnovAge PACE Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$112.50
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC FOREARM
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$532.60
|
| 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 |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$532.34
|
| Rate for Payer: Blue Shield of California EPN |
$348.17
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: Cigna of CA HMO |
$561.28
|
| Rate for Payer: Cigna of CA PPO |
$648.98
|
| 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 |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| 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 |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| 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 |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| 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 |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| 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
|
|
