|
HC AFO MOLDED GAUNTLET
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
915351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$387.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.76
|
| Rate for Payer: Blue Shield of California Commercial |
$696.67
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
915351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$387.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.76
|
| Rate for Payer: Blue Shield of California Commercial |
$696.67
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
915351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.12
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
915351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: Adventist Health Commercial |
$435.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$797.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.69
|
| Rate for Payer: Blue Shield of California Commercial |
$784.49
|
| Rate for Payer: Blue Shield of California EPN |
$516.62
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$903.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$903.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$903.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.10
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$903.55
|
| Rate for Payer: Vantage Medical Group Senior |
$903.55
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.12
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: Adventist Health Commercial |
$435.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$797.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.69
|
| Rate for Payer: Blue Shield of California Commercial |
$784.49
|
| Rate for Payer: Blue Shield of California EPN |
$516.62
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$903.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$903.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$903.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.10
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$903.55
|
| Rate for Payer: Vantage Medical Group Senior |
$903.55
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
915351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
915351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
915351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
915351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.84 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$242.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.31
|
| Rate for Payer: Blue Shield of California Commercial |
$436.16
|
| Rate for Payer: Blue Shield of California EPN |
$287.23
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$368.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.84 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$242.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.31
|
| Rate for Payer: Blue Shield of California Commercial |
$436.16
|
| Rate for Payer: Blue Shield of California EPN |
$287.23
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$368.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
915351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.04 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Adventist Health Commercial |
$510.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$934.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$721.68
|
| Rate for Payer: Blue Shield of California Commercial |
$919.55
|
| Rate for Payer: Blue Shield of California EPN |
$605.56
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$754.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.20
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.10
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$249.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.04
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.04 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Adventist Health Commercial |
$510.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$934.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$721.68
|
| Rate for Payer: Blue Shield of California Commercial |
$919.55
|
| Rate for Payer: Blue Shield of California EPN |
$605.56
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$754.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.20
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.10
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
915351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$249.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.04
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
905351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.08 |
| Max. Negotiated Rate |
$1,013.20 |
| Rate for Payer: Adventist Health Commercial |
$488.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$655.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.41
|
| Rate for Payer: Blue Shield of California Commercial |
$879.70
|
| Rate for Payer: Blue Shield of California EPN |
$579.31
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,013.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,013.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$834.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$834.40
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$596.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,013.20
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
915351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.08 |
| Max. Negotiated Rate |
$1,013.20 |
| Rate for Payer: Adventist Health Commercial |
$488.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$655.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.41
|
| Rate for Payer: Blue Shield of California Commercial |
$879.70
|
| Rate for Payer: Blue Shield of California EPN |
$579.31
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,013.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,013.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$834.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$834.40
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$596.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,013.20
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
915351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$238.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$596.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
905351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$238.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$596.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
915351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.65
|
| Rate for Payer: Blue Shield of California Commercial |
$360.14
|
| Rate for Payer: Blue Shield of California EPN |
$237.17
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
