|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
905351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.81
|
| Rate for Payer: Blue Shield of California Commercial |
$375.64
|
| Rate for Payer: Blue Shield of California EPN |
$247.37
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.30
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$254.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.03
|
| Rate for Payer: United Healthcare All Other HMO |
$185.94
|
| Rate for Payer: United Healthcare HMO Rider |
$181.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.65
|
| Rate for Payer: Vantage Medical Group Senior |
$432.65
|
|
|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
915351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$254.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.03
|
| Rate for Payer: United Healthcare All Other HMO |
$185.94
|
| Rate for Payer: United Healthcare HMO Rider |
$181.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.70
|
|
|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
915351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.81
|
| Rate for Payer: Blue Shield of California Commercial |
$375.64
|
| Rate for Payer: Blue Shield of California EPN |
$247.37
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.30
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$254.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.03
|
| Rate for Payer: United Healthcare All Other HMO |
$185.94
|
| Rate for Payer: United Healthcare HMO Rider |
$181.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.65
|
| Rate for Payer: Vantage Medical Group Senior |
$432.65
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
915351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.53
|
| Rate for Payer: Blue Shield of California EPN |
$687.20
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.53
|
| Rate for Payer: Blue Shield of California EPN |
$687.20
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
915351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
|
|
HC AFO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
905351901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC AFO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
905351901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
915351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,691.50 |
| Rate for Payer: Adventist Health Commercial |
$815.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,094.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,492.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,152.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,468.62
|
| Rate for Payer: Blue Shield of California EPN |
$967.14
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,691.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,691.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$931.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,053.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,231.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,393.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,393.00
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,691.50
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,691.50 |
| Rate for Payer: Adventist Health Commercial |
$815.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,094.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,492.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,152.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,468.62
|
| Rate for Payer: Blue Shield of California EPN |
$967.14
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,691.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,691.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$931.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,053.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,231.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,393.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,393.00
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,691.50
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$398.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$758.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,231.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
915351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$398.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$758.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,231.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
|
|
HC AFO FX RIGID
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
915352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC AFO FX RIGID
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC AFO FX RIGID
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
915352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$886.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.14
|
| Rate for Payer: Blue Shield of California EPN |
$743.58
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$802.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC AFO FX RIGID
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$886.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.14
|
| Rate for Payer: Blue Shield of California EPN |
$743.58
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$802.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
905352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO |
$422.80
|
| Rate for Payer: Cigna of CA PPO |
$422.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Senior |
$241.60
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$302.00
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.68
|
| Rate for Payer: United Healthcare All Other HMO |
$220.64
|
| Rate for Payer: United Healthcare HMO Rider |
$215.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.81
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
915352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$715.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.96
|
| Rate for Payer: Blue Shield of California Commercial |
$959.40
|
| Rate for Payer: Blue Shield of California EPN |
$631.80
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna of CA HMO |
$910.00
|
| Rate for Payer: Cigna of CA PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,105.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$520.00
|
| Rate for Payer: Galaxy Health WC |
$1,105.00
|
| Rate for Payer: Global Benefits Group Commercial |
$780.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$824.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$804.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$910.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$910.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$780.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$780.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.89
|
| Rate for Payer: United Healthcare All Other HMO |
$474.89
|
| Rate for Payer: United Healthcare HMO Rider |
$464.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,105.00
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
915352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$260.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna of CA HMO |
$910.00
|
| Rate for Payer: Cigna of CA PPO |
$910.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$520.00
|
| Rate for Payer: Galaxy Health WC |
$1,105.00
|
| Rate for Payer: Global Benefits Group Commercial |
$780.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$804.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.89
|
| Rate for Payer: United Healthcare All Other HMO |
$474.89
|
| Rate for Payer: United Healthcare HMO Rider |
$464.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.75
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
905352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.96 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Adventist Health Commercial |
$247.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.84
|
| Rate for Payer: Blue Shield of California Commercial |
$445.75
|
| Rate for Payer: Blue Shield of California EPN |
$293.54
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO |
$422.80
|
| Rate for Payer: Cigna of CA PPO |
$422.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Senior |
$241.60
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$824.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.80
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$302.00
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.68
|
| Rate for Payer: United Healthcare All Other HMO |
$220.64
|
| Rate for Payer: United Healthcare HMO Rider |
$215.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.40
|
| Rate for Payer: Vantage Medical Group Senior |
$513.40
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
915351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$70.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.62
|
| Rate for Payer: Blue Shield of California Commercial |
$126.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.59
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.40
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$70.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.62
|
| Rate for Payer: Blue Shield of California Commercial |
$126.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.59
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.40
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
915351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
