|
HC AFO POST, SINGLE BAR
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
915351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| 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: 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: 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
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
905351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| 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: 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: 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
|
|
|
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
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
915351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$420.48 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: Adventist Health Commercial |
$718.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,314.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,014.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,292.98
|
| Rate for Payer: Blue Shield of California EPN |
$851.47
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$942.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,226.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,226.40
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,489.20
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
915351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
905351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
905351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$420.48 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: Adventist Health Commercial |
$718.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,314.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,014.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,292.98
|
| Rate for Payer: Blue Shield of California EPN |
$851.47
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$942.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,226.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,226.40
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,489.20
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.84 |
| Max. Negotiated Rate |
$651.10 |
| Rate for Payer: Adventist Health Commercial |
$314.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$421.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.67
|
| Rate for Payer: Blue Shield of California Commercial |
$565.31
|
| Rate for Payer: Blue Shield of California EPN |
$372.28
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$651.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$651.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$651.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$536.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$536.20
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$651.10
|
| Rate for Payer: Vantage Medical Group Senior |
$651.10
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
915351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.84
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
915351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.84 |
| Max. Negotiated Rate |
$651.10 |
| Rate for Payer: Adventist Health Commercial |
$314.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$421.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.67
|
| Rate for Payer: Blue Shield of California Commercial |
$565.31
|
| Rate for Payer: Blue Shield of California EPN |
$372.28
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$651.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$651.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$651.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$536.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$536.20
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$651.10
|
| Rate for Payer: Vantage Medical Group Senior |
$651.10
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.84
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
905351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.50
|
| Rate for Payer: Blue Shield of California Commercial |
$698.89
|
| Rate for Payer: Blue Shield of California EPN |
$460.24
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$594.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
905351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
915351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.50
|
| Rate for Payer: Blue Shield of California Commercial |
$698.89
|
| Rate for Payer: Blue Shield of California EPN |
$460.24
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$594.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
915351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
915351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.48 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Adventist Health Commercial |
$656.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,201.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.28
|
| Rate for Payer: Blue Shield of California EPN |
$778.57
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,361.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$734.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,121.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,121.40
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,361.70
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.48 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Adventist Health Commercial |
$656.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,201.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.28
|
| Rate for Payer: Blue Shield of California EPN |
$778.57
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,361.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$734.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,121.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,121.40
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,361.70
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
915351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.48
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.48
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
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 |
$886.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.07
|
| 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 SPIRAL PREFAB FIT & ADJ
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
915351951
|
|
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 SPIRAL PREFAB FIT & ADJ
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
915351951
|
|
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 |
$886.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.07
|
| 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 SPIRAL PREFAB FIT & ADJ
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
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 SPRINGWIRE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$204.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.02
|
| Rate for Payer: Blue Shield of California Commercial |
$368.26
|
| Rate for Payer: Blue Shield of California EPN |
$242.51
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
|
