|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$858.50 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.99
|
| Rate for Payer: Blue Shield of California Commercial |
$745.38
|
| Rate for Payer: Blue Shield of California EPN |
$490.86
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
|
|
HC FX ORTHOSIS PLASTIC AFO
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
915352106
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$858.50 |
| Rate for Payer: Adventist Health Commercial |
$414.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$555.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$757.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.99
|
| Rate for Payer: Blue Shield of California Commercial |
$745.38
|
| Rate for Payer: Blue Shield of California EPN |
$490.86
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cash Price |
$555.50
|
| Rate for Payer: Cigna of CA HMO |
$707.00
|
| Rate for Payer: Cigna of CA PPO |
$707.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$858.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$858.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$404.00
|
| Rate for Payer: Galaxy Health WC |
$858.50
|
| Rate for Payer: Global Benefits Group Commercial |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$808.00
|
| Rate for Payer: Networks By Design Commercial |
$505.00
|
| Rate for Payer: Prime Health Services Commercial |
$858.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.05
|
| Rate for Payer: United Healthcare All Other HMO |
$368.95
|
| Rate for Payer: United Healthcare HMO Rider |
$360.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$858.50
|
| Rate for Payer: Vantage Medical Group Senior |
$858.50
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.43
|
| Rate for Payer: Blue Shield of California Commercial |
$637.63
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
905352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$354.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.43
|
| Rate for Payer: Blue Shield of California Commercial |
$637.63
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$398.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC FX ORTHOSIS SOFT AFO
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
915352112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$308.56 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.23
|
| Rate for Payer: Blue Shield of California Commercial |
$197.78
|
| Rate for Payer: Blue Shield of California EPN |
$130.25
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC FX ORTHOSIS SYNTHETIC AFO
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L2106
|
| Hospital Charge Code |
905352104
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
915353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.50
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.50
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
915353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
HC FX OX ADD SOCK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.48
|
| Rate for Payer: Blue Shield of California Commercial |
$167.53
|
| Rate for Payer: Blue Shield of California EPN |
$110.32
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
915352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.48
|
| Rate for Payer: Blue Shield of California Commercial |
$167.53
|
| Rate for Payer: Blue Shield of California EPN |
$110.32
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
915352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC FX OX DROP LOCK
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
915352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$215.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.08
|
| Rate for Payer: Blue Shield of California Commercial |
$387.45
|
| Rate for Payer: Blue Shield of California EPN |
$255.15
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC FX OX DROP LOCK
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
915352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC FX OX DROP LOCK
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$215.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.08
|
| Rate for Payer: Blue Shield of California Commercial |
$387.45
|
| Rate for Payer: Blue Shield of California EPN |
$255.15
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC FX OX DROP LOCK
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
915352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
915352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.96 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Adventist Health Commercial |
$319.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$428.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$584.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.20
|
| Rate for Payer: Blue Shield of California Commercial |
$574.90
|
| Rate for Payer: Blue Shield of California EPN |
$378.59
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$662.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$662.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$545.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$545.30
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$662.15
|
| Rate for Payer: Vantage Medical Group Senior |
$662.15
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.96 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Adventist Health Commercial |
$319.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$428.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$584.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.20
|
| Rate for Payer: Blue Shield of California Commercial |
$574.90
|
| Rate for Payer: Blue Shield of California EPN |
$378.59
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cash Price |
$428.45
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$662.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$662.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$545.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$545.30
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$662.15
|
| Rate for Payer: Vantage Medical Group Senior |
$662.15
|
|
