|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.92
|
| 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 |
$317.20
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,112.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.68
|
| 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 |
$1,138.80
|
| 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 |
915351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,112.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.68
|
| 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 |
$1,138.80
|
| 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 |
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 |
$1,060.49
|
| Rate for Payer: Blue Shield of California Commercial |
$888.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$942.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,112.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.68
|
| 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
|
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 |
$1,060.49
|
| Rate for Payer: Blue Shield of California Commercial |
$888.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$942.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,112.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.68
|
| 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
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
915351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.94
|
| 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 |
$497.90
|
| 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
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.94
|
| 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 |
$497.90
|
| 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 |
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 |
$463.66
|
| Rate for Payer: Blue Shield of California Commercial |
$589.05
|
| Rate for Payer: Blue Shield of California Commercial |
$388.36
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.94
|
| 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
|
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 |
$463.66
|
| Rate for Payer: Blue Shield of California Commercial |
$589.05
|
| Rate for Payer: Blue Shield of California Commercial |
$388.36
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.94
|
| 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 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 |
$573.22
|
| Rate for Payer: Blue Shield of California Commercial |
$728.24
|
| Rate for Payer: Blue Shield of California Commercial |
$480.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$594.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| 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 |
$615.55
|
| 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 |
$573.22
|
| Rate for Payer: Blue Shield of California Commercial |
$728.24
|
| Rate for Payer: Blue Shield of California Commercial |
$480.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$594.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| 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 |
$615.55
|
| 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 |
$969.69
|
| Rate for Payer: Blue Shield of California Commercial |
$812.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,231.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$734.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.18
|
| 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
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,017.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.18
|
| 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 |
$1,041.30
|
| 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 |
915351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,017.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.18
|
| 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 |
$1,041.30
|
| 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
|
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: 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 |
$969.69
|
| Rate for Payer: Blue Shield of California Commercial |
$812.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,231.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$734.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.18
|
| 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 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 |
$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 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 |
$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 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 |
$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 |
$886.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,003.07
|
| 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 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 |
$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 |
$886.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,003.07
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| 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 |
$324.35
|
| 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
|
|
|
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 |
$302.04
|
| Rate for Payer: Blue Shield of California Commercial |
$383.73
|
| Rate for Payer: Blue Shield of California Commercial |
$252.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| 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
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
905351900
|
|
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 |
$302.04
|
| Rate for Payer: Blue Shield of California Commercial |
$383.73
|
| Rate for Payer: Blue Shield of California Commercial |
$252.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| 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 |
905351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| 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 |
$324.35
|
| 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
|
|
