|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
905351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.03
|
| Rate for Payer: United Healthcare All Other HMO |
$185.94
|
| Rate for Payer: United Healthcare HMO Rider |
$181.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.70
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$855.89
|
| Rate for Payer: Blue Shield of California Commercial |
$716.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,087.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
915351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| 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 |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| 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 |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
915351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$855.89
|
| Rate for Payer: Blue Shield of California Commercial |
$716.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,087.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| 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 ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
905351901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.19
|
| Rate for Payer: Blue Shield of California Commercial |
$17.75
|
| Rate for Payer: Blue Shield of California Commercial |
$26.91
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC AFO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
905351901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
915351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,691.50 |
| Rate for Payer: Adventist Health Commercial |
$815.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,094.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,492.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,204.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,530.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.93
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,691.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,691.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$931.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,053.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,174.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,393.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,393.00
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,691.50
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
915351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$398.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,174.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$1,293.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,691.50 |
| Rate for Payer: Adventist Health Commercial |
$815.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,094.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,492.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,204.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,530.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.93
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,691.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,691.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$931.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,053.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,174.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,393.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,393.00
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,691.50
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Adventist Health Commercial |
$398.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Senior |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,174.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.00
|
| Rate for Payer: Networks By Design Commercial |
$1,293.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.85
|
| Rate for Payer: United Healthcare All Other HMO |
$726.95
|
| Rate for Payer: United Healthcare HMO Rider |
$711.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.73
|
|
|
HC AFO FX RIGID
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC AFO FX RIGID
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.11
|
| Rate for Payer: Blue Shield of California Commercial |
$775.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,176.57
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$802.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$907.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC AFO FX RIGID
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
915352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.11
|
| Rate for Payer: Blue Shield of California Commercial |
$775.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,176.57
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$802.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$907.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC AFO FX RIGID
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
915352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
915352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$715.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$786.89
|
| Rate for Payer: Blue Shield of California Commercial |
$999.70
|
| Rate for Payer: Blue Shield of California Commercial |
$659.10
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna of CA HMO |
$910.00
|
| Rate for Payer: Cigna of CA PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,105.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$910.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$520.00
|
| Rate for Payer: Galaxy Health WC |
$1,105.00
|
| Rate for Payer: Global Benefits Group Commercial |
$780.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$825.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$824.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$767.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$910.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$910.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$780.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$780.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.89
|
| Rate for Payer: United Healthcare All Other HMO |
$474.89
|
| Rate for Payer: United Healthcare HMO Rider |
$464.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,105.00
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
905352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.96 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Adventist Health Commercial |
$247.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.60
|
| Rate for Payer: Blue Shield of California Commercial |
$464.48
|
| Rate for Payer: Blue Shield of California Commercial |
$306.23
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO |
$422.80
|
| Rate for Payer: Cigna of CA PPO |
$422.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Senior |
$241.60
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$824.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.80
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$302.00
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.68
|
| Rate for Payer: United Healthcare All Other HMO |
$220.64
|
| Rate for Payer: United Healthcare HMO Rider |
$215.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.40
|
| Rate for Payer: Vantage Medical Group Senior |
$513.40
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
905352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO |
$422.80
|
| Rate for Payer: Cigna of CA PPO |
$422.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Senior |
$241.60
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$392.60
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.68
|
| Rate for Payer: United Healthcare All Other HMO |
$220.64
|
| Rate for Payer: United Healthcare HMO Rider |
$215.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.81
|
|
|
HC AFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT L2114
|
| Hospital Charge Code |
915352114
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$260.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna of CA HMO |
$910.00
|
| Rate for Payer: Cigna of CA PPO |
$910.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$910.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$520.00
|
| Rate for Payer: Galaxy Health WC |
$1,105.00
|
| Rate for Payer: Global Benefits Group Commercial |
$780.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$825.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$767.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.89
|
| Rate for Payer: United Healthcare All Other HMO |
$474.89
|
| Rate for Payer: United Healthcare HMO Rider |
$464.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.75
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
915351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$70.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.11
|
| Rate for Payer: Blue Shield of California Commercial |
$132.27
|
| Rate for Payer: Blue Shield of California Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.40
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$70.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.11
|
| Rate for Payer: Blue Shield of California Commercial |
$132.27
|
| Rate for Payer: Blue Shield of California Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.40
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
915351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
|
HC AFO 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$599.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.96
|
| 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 |
$613.60
|
| 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
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$599.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.96
|
| 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 |
$613.60
|
| 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
|
|
