|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$535.20 |
| Max. Negotiated Rate |
$2,408.40 |
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.40
|
| Rate for Payer: Galaxy Health WC |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,408.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.20
|
| Rate for Payer: Multiplan Commercial |
$2,007.00
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
|
|
HC FO MODIFIED PIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$118.80 |
| 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 |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$99.00
|
| Rate for Payer: Blue Shield of California EPN |
$71.81
|
| 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 Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| 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 |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FO MODIFIED PIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Blue Shield of California EPN |
$70.49
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$26.40
|
| 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: United Healthcare All Other Commercial |
$49.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.68
|
| Rate for Payer: United Healthcare HMO Rider |
$47.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.96
|
| Rate for Payer: Blue Distinction Transplant |
$198.00
|
| Rate for Payer: Blue Shield of California Commercial |
$247.50
|
| Rate for Payer: Blue Shield of California EPN |
$179.52
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Media |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$247.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.00
|
| Rate for Payer: United Healthcare All Other HMO |
$165.00
|
| Rate for Payer: United Healthcare HMO Rider |
$165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Blue Shield of California EPN |
$176.22
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.61
|
| Rate for Payer: United Healthcare All Other HMO |
$121.70
|
| Rate for Payer: United Healthcare HMO Rider |
$119.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.90
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$890.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.65
|
| Rate for Payer: Blue Distinction Transplant |
$593.40
|
| Rate for Payer: Blue Shield of California Commercial |
$611.20
|
| Rate for Payer: Blue Shield of California EPN |
$480.65
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: Cigna of CA HMO |
$632.96
|
| Rate for Payer: Cigna of CA PPO |
$731.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$741.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$593.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$593.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.80 |
| Max. Negotiated Rate |
$890.10 |
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.15 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.03
|
| Rate for Payer: Blue Distinction Transplant |
$89.40
|
| Rate for Payer: Blue Shield of California Commercial |
$111.75
|
| Rate for Payer: Blue Shield of California EPN |
$81.06
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Media |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.09
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Riverside University Health System MISP |
$59.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.50
|
| Rate for Payer: United Healthcare All Other HMO |
$74.50
|
| Rate for Payer: United Healthcare HMO Rider |
$74.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Blue Shield of California EPN |
$79.57
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.26
|
| Rate for Payer: United Healthcare All Other HMO |
$54.95
|
| Rate for Payer: United Healthcare HMO Rider |
$53.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.17
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$631.41 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,150.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,012.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,235.36
|
| Rate for Payer: Blue Distinction Transplant |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,568.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,137.50
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Media |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,568.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$731.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,116.59
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.56
|
| Rate for Payer: United Healthcare All Other HMO |
$771.16
|
| Rate for Payer: United Healthcare HMO Rider |
$754.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.03
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Blue Shield of California EPN |
$303.85
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.85
|
| Rate for Payer: United Healthcare All Other HMO |
$209.85
|
| Rate for Payer: United Healthcare HMO Rider |
$205.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.77
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.41 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.17
|
| Rate for Payer: Blue Distinction Transplant |
$341.40
|
| Rate for Payer: Blue Shield of California Commercial |
$426.75
|
| Rate for Payer: Blue Shield of California EPN |
$309.54
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Media |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$426.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.50
|
| Rate for Payer: United Healthcare All Other HMO |
$284.50
|
| Rate for Payer: United Healthcare HMO Rider |
$284.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
OP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,568.68 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,818.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,818.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,883.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,398.81
|
| Rate for Payer: Blue Distinction Transplant |
$8,529.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,662.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,733.50
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,083.60
|
| Rate for Payer: Dignity Health Media |
$12,083.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,662.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,975.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,568.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,828.56
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: Riverside University Health System MISP |
$5,686.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,529.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,108.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,108.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,083.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,083.60
|
|
|
HC FOOT FLEX FOOT SYSTEM
|
Facility
|
IP
|
$14,216.00
|
|
|
Service Code
|
CPT L5980
|
| Hospital Charge Code |
905355980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,843.20 |
| Max. Negotiated Rate |
$12,794.40 |
| Rate for Payer: Blue Shield of California EPN |
$7,591.34
|
| Rate for Payer: Cash Price |
$6,397.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,372.80
|
| Rate for Payer: Cigna of CA HMO |
$9,951.20
|
| Rate for Payer: Cigna of CA PPO |
$9,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,686.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,686.40
|
| Rate for Payer: Galaxy Health WC |
$12,083.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,529.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,416.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,843.20
|
| Rate for Payer: Multiplan Commercial |
$10,662.00
|
| Rate for Payer: Networks By Design Commercial |
$7,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,083.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,367.96
|
| Rate for Payer: United Healthcare All Other HMO |
$5,242.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5,129.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,691.28
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.55 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$601.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$529.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$645.74
|
| Rate for Payer: Blue Distinction Transplant |
$655.80
|
| Rate for Payer: Blue Shield of California Commercial |
$819.75
|
| Rate for Payer: Blue Shield of California EPN |
$594.59
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.05
|
| Rate for Payer: Dignity Health Media |
$929.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$819.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$382.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.13
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Riverside University Health System MISP |
$437.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.50
|
| Rate for Payer: United Healthcare All Other HMO |
$546.50
|
| Rate for Payer: United Healthcare HMO Rider |
$546.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.05
|
| Rate for Payer: Vantage Medical Group Senior |
$929.05
|
|
|
HC FOOT FLEXIBLE KEEL SAFE/STEN
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT L5972
|
| Hospital Charge Code |
905355972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Blue Shield of California EPN |
$583.66
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$765.10
|
| Rate for Payer: Cigna of CA PPO |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$546.50
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.72
|
| Rate for Payer: United Healthcare All Other HMO |
$403.10
|
| Rate for Payer: United Healthcare HMO Rider |
$394.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.69
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
OP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,769.86 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,814.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,814.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,238.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,171.86
|
| Rate for Payer: Blue Distinction Transplant |
$5,252.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,565.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,762.18
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,440.90
|
| Rate for Payer: Dignity Health Media |
$7,440.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,565.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,063.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,589.14
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$4,377.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: Riverside University Health System MISP |
$3,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,377.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,377.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,440.90
|
|
|
HC FOOT FLEX WALK OR EQUAL
|
Facility
|
IP
|
$8,754.00
|
|
|
Service Code
|
CPT L5981
|
| Hospital Charge Code |
905355981
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,750.80 |
| Max. Negotiated Rate |
$7,878.60 |
| Rate for Payer: Blue Shield of California EPN |
$4,674.64
|
| Rate for Payer: Cash Price |
$3,939.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,003.20
|
| Rate for Payer: Cigna of CA HMO |
$6,127.80
|
| Rate for Payer: Cigna of CA PPO |
$6,127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,501.60
|
| Rate for Payer: Galaxy Health WC |
$7,440.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,878.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,838.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,335.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.80
|
| Rate for Payer: Multiplan Commercial |
$6,565.50
|
| Rate for Payer: Networks By Design Commercial |
$4,377.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,228.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3,158.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,888.82
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Distinction Transplant |
$460.80
|
| Rate for Payer: Blue Shield of California Commercial |
$474.62
|
| Rate for Payer: Blue Shield of California EPN |
$373.25
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: Cigna of CA HMO |
$491.52
|
| Rate for Payer: Cigna of CA PPO |
$568.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$460.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$460.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FOOT MULTIAXIAL ANKLE/FOOT
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT L5978
|
| Hospital Charge Code |
905355978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Blue Shield of California EPN |
$834.11
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| 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: United Healthcare All Other Commercial |
$589.81
|
| Rate for Payer: United Healthcare All Other HMO |
$576.07
|
| Rate for Payer: United Healthcare HMO Rider |
$563.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$515.46
|
|
|
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 |
$339.04 |
| Max. Negotiated Rate |
$1,405.80 |
| 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 |
$859.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$756.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$922.83
|
| Rate for Payer: Blue Distinction Transplant |
$937.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.50
|
| Rate for Payer: Blue Shield of California EPN |
$849.73
|
| 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 Media |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,171.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$546.70
|
| 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: LLUH Dept of Risk Management WC |
$640.42
|
| 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 |
$781.00
|
| Rate for Payer: United Healthcare All Other HMO |
$781.00
|
| Rate for Payer: United Healthcare HMO Rider |
$781.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
