|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$7,646.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,529.20 |
| Max. Negotiated Rate |
$6,881.40 |
| Rate for Payer: Adventist Health Commercial |
$1,529.20
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,058.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,058.40
|
| Rate for Payer: Galaxy Health WC |
$6,499.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,587.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,881.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,913.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,732.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.20
|
| Rate for Payer: Multiplan Commercial |
$5,734.50
|
| Rate for Payer: Networks By Design Commercial |
$4,969.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,499.10
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$7,646.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$1,529.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,116.80
|
| Rate for Payer: Cigna of CA HMO |
$4,893.44
|
| Rate for Payer: Cigna of CA PPO |
$5,658.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,499.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,587.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,881.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$5,734.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$4,969.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$6,499.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,823.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,823.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,823.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$8,191.80 |
| Rate for Payer: Adventist Health Commercial |
$1,820.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$5,006.10
|
| Rate for Payer: Cash Price |
$5,006.10
|
| Rate for Payer: Cash Price |
$5,006.10
|
| Rate for Payer: Cash Price |
$5,006.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,281.60
|
| Rate for Payer: Cigna of CA HMO |
$5,825.28
|
| Rate for Payer: Cigna of CA PPO |
$6,735.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$7,736.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,191.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,820.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$6,826.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$5,916.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$7,736.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,461.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,551.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,551.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,551.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,551.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,820.40 |
| Max. Negotiated Rate |
$8,191.80 |
| Rate for Payer: Adventist Health Commercial |
$1,820.40
|
| Rate for Payer: Cash Price |
$5,006.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,640.80
|
| Rate for Payer: Galaxy Health WC |
$7,736.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,191.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,634.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,820.40
|
| Rate for Payer: Multiplan Commercial |
$6,826.50
|
| Rate for Payer: Networks By Design Commercial |
$5,916.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,736.70
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$7,911.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,582.20 |
| Max. Negotiated Rate |
$7,119.90 |
| Rate for Payer: Adventist Health Commercial |
$1,582.20
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,328.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,164.40
|
| Rate for Payer: Galaxy Health WC |
$6,724.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,746.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,119.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,014.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,896.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,582.20
|
| Rate for Payer: Multiplan Commercial |
$5,933.25
|
| Rate for Payer: Networks By Design Commercial |
$5,142.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,724.35
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$7,911.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,119.90 |
| Rate for Payer: Adventist Health Commercial |
$1,582.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,328.80
|
| Rate for Payer: Cigna of CA HMO |
$5,063.04
|
| Rate for Payer: Cigna of CA PPO |
$5,854.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,724.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,746.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,119.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,582.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$5,933.25
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$5,142.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$6,724.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,746.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,955.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,955.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,955.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,955.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FUNCTIONAL CAPACITY MEASURE OT
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 97670
|
| Hospital Charge Code |
903207670
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Adventist Health Commercial |
$278.60
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
|
|
HC FUNCTIONAL CAPACITY MEASURE OT
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 97670
|
| Hospital Charge Code |
903207670
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Adventist Health Commercial |
$571.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$845.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,044.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Cash Price |
$766.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: Cigna of CA HMO |
$891.52
|
| Rate for Payer: Cigna of CA PPO |
$1,030.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,184.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: InnovAge PACE Commercial |
$696.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$975.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$975.10
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
| Rate for Payer: Riverside University Health System MISP |
$557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$835.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$835.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.05
|
|
|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,783.80 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Cash Price |
$6,590.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,783.80 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,276.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,986.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,801.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,037.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,321.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,780.82
|
| Rate for Payer: Cash Price |
$6,590.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5,991.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,387.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,387.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,792.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,991.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$13,072.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Adventist Health Commercial |
$2,614.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$7,189.60
|
| Rate for Payer: Cash Price |
$7,189.60
|
| Rate for Payer: Cash Price |
$7,189.60
|
| Rate for Payer: Cash Price |
$7,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,457.60
|
| Rate for Payer: Cigna of CA HMO |
$8,366.08
|
| Rate for Payer: Cigna of CA PPO |
$9,673.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$11,111.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,764.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,719.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,614.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,804.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,496.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$11,111.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,843.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,536.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,536.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,536.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$13,072.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,614.40 |
| Max. Negotiated Rate |
$11,764.80 |
| Rate for Payer: Adventist Health Commercial |
$2,614.40
|
| Rate for Payer: Cash Price |
$7,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,457.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,228.80
|
| Rate for Payer: Galaxy Health WC |
$11,111.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,764.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,719.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,980.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,091.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,614.40
|
| Rate for Payer: Multiplan Commercial |
$9,804.00
|
| Rate for Payer: Networks By Design Commercial |
$8,496.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,111.20
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.35 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.08
|
| Rate for Payer: InnovAge PACE Commercial |
$1,084.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Riverside University Health System MISP |
$867.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
915352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.80
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.35 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$889.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,626.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,843.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,843.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.08
|
| Rate for Payer: InnovAge PACE Commercial |
$1,084.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,518.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,518.30
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Riverside University Health System MISP |
$867.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Adventist Health Commercial |
$433.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,093.18
|
| Rate for Payer: Cash Price |
$1,192.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,342.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.80
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,409.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.03
|
| Rate for Payer: United Healthcare All Other HMO |
$792.34
|
| Rate for Payer: United Healthcare HMO Rider |
$775.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.35
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California Commercial |
$397.32
|
| Rate for Payer: Blue Shield of California EPN |
$259.06
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
|
|
HC FX ORTHOSIS PLASTER AFO
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352102
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.34 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$210.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$397.32
|
| Rate for Payer: Blue Shield of California EPN |
$259.06
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$359.80
|
| Rate for Payer: Cigna of CA PPO |
$359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$257.00
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.90
|
| Rate for Payer: United Healthcare All Other HMO |
$187.76
|
| Rate for Payer: United Healthcare HMO Rider |
$183.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California Commercial |
$780.73
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California Commercial |
$780.73
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$656.50
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.17
|
| Rate for Payer: Blue Shield of California Commercial |
$780.73
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: InnovAge PACE Commercial |
$505.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Riverside University Health System MISP |
$404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.17
|
| Rate for Payer: Blue Shield of California Commercial |
$780.73
|
| Rate for Payer: Blue Shield of California EPN |
$509.04
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Central Health Plan Commercial |
$808.00
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.33
|
| Rate for Payer: InnovAge PACE Commercial |
$505.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Riverside University Health System MISP |
$404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
