|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
915351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Blue Shield of California Commercial |
$132.96
|
| Rate for Payer: Blue Shield of California EPN |
$86.69
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$70.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.02
|
| Rate for Payer: Blue Shield of California Commercial |
$132.96
|
| Rate for Payer: Blue Shield of California EPN |
$86.69
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: InnovAge PACE Commercial |
$86.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Riverside University Health System MISP |
$68.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Blue Shield of California Commercial |
$132.96
|
| Rate for Payer: Blue Shield of California EPN |
$86.69
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.55
|
| Rate for Payer: United Healthcare All Other HMO |
$62.83
|
| Rate for Payer: United Healthcare HMO Rider |
$61.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.33
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
915351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.16 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$387.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.41
|
| Rate for Payer: Blue Shield of California Commercial |
$729.71
|
| Rate for Payer: Blue Shield of California EPN |
$475.78
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.17
|
| Rate for Payer: InnovAge PACE Commercial |
$472.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Riverside University Health System MISP |
$377.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
915351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.71
|
| Rate for Payer: Blue Shield of California EPN |
$475.78
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.71
|
| Rate for Payer: Blue Shield of California EPN |
$475.78
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.16 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$387.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.41
|
| Rate for Payer: Blue Shield of California Commercial |
$729.71
|
| Rate for Payer: Blue Shield of California EPN |
$475.78
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.17
|
| Rate for Payer: InnovAge PACE Commercial |
$472.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Riverside University Health System MISP |
$377.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.28
|
| Rate for Payer: United Healthcare All Other HMO |
$344.84
|
| Rate for Payer: United Healthcare HMO Rider |
$337.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Blue Shield of California Commercial |
$821.70
|
| Rate for Payer: Blue Shield of California EPN |
$535.75
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.13 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$435.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$797.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$624.30
|
| Rate for Payer: Blue Shield of California Commercial |
$821.70
|
| Rate for Payer: Blue Shield of California EPN |
$535.75
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$903.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$903.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$903.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$598.35
|
| Rate for Payer: InnovAge PACE Commercial |
$531.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.10
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$903.55
|
| Rate for Payer: Vantage Medical Group Senior |
$903.55
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
915351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Blue Shield of California Commercial |
$821.70
|
| Rate for Payer: Blue Shield of California EPN |
$535.75
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
915351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.13 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$435.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$797.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$624.30
|
| Rate for Payer: Blue Shield of California Commercial |
$821.70
|
| Rate for Payer: Blue Shield of California EPN |
$535.75
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Cash Price |
$584.65
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$903.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$903.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$903.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$598.35
|
| Rate for Payer: InnovAge PACE Commercial |
$531.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.10
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.94
|
| Rate for Payer: United Healthcare All Other HMO |
$388.31
|
| Rate for Payer: United Healthcare HMO Rider |
$379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$903.55
|
| Rate for Payer: Vantage Medical Group Senior |
$903.55
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
915351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.08
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
915351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.08
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
915351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Blue Shield of California Commercial |
$456.84
|
| Rate for Payer: Blue Shield of California EPN |
$297.86
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.20
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
915351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Adventist Health Commercial |
$242.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.09
|
| Rate for Payer: Blue Shield of California Commercial |
$456.84
|
| Rate for Payer: Blue Shield of California EPN |
$297.86
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$377.61
|
| Rate for Payer: InnovAge PACE Commercial |
$295.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Riverside University Health System MISP |
$236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Adventist Health Commercial |
$242.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.09
|
| Rate for Payer: Blue Shield of California Commercial |
$456.84
|
| Rate for Payer: Blue Shield of California EPN |
$297.86
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$377.61
|
| Rate for Payer: InnovAge PACE Commercial |
$295.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Riverside University Health System MISP |
$236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Blue Shield of California Commercial |
$456.84
|
| Rate for Payer: Blue Shield of California EPN |
$297.86
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.20
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.80
|
| Rate for Payer: United Healthcare All Other HMO |
$215.89
|
| Rate for Payer: United Healthcare HMO Rider |
$211.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.55
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$408.06 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Adventist Health Commercial |
$510.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$934.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.78
|
| Rate for Payer: Blue Shield of California Commercial |
$963.16
|
| Rate for Payer: Blue Shield of California EPN |
$627.98
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$772.76
|
| Rate for Payer: InnovAge PACE Commercial |
$623.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.20
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: Riverside University Health System MISP |
$498.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.10
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
915351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$408.06 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Adventist Health Commercial |
$510.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$934.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.78
|
| Rate for Payer: Blue Shield of California Commercial |
$963.16
|
| Rate for Payer: Blue Shield of California EPN |
$627.98
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$772.76
|
| Rate for Payer: InnovAge PACE Commercial |
$623.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.20
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: Riverside University Health System MISP |
$498.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.10
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
915351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Adventist Health Commercial |
$249.20
|
| Rate for Payer: Blue Shield of California Commercial |
$963.16
|
| Rate for Payer: Blue Shield of California EPN |
$627.98
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.20
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$809.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Adventist Health Commercial |
$249.20
|
| Rate for Payer: Blue Shield of California Commercial |
$963.16
|
| Rate for Payer: Blue Shield of California EPN |
$627.98
|
| Rate for Payer: Cash Price |
$685.30
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.20
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$809.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.62
|
| Rate for Payer: United Healthcare All Other HMO |
$455.16
|
| Rate for Payer: United Healthcare HMO Rider |
$445.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.06
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
915351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$1,072.80 |
| Rate for Payer: Adventist Health Commercial |
$238.40
|
| Rate for Payer: Blue Shield of California Commercial |
$921.42
|
| Rate for Payer: Blue Shield of California EPN |
$600.77
|
| Rate for Payer: Cash Price |
$655.60
|
| Rate for Payer: Central Health Plan Commercial |
$953.60
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,072.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.40
|
| Rate for Payer: Multiplan Commercial |
$894.00
|
| Rate for Payer: Networks By Design Commercial |
$774.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
905351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$390.38 |
| Max. Negotiated Rate |
$1,072.80 |
| Rate for Payer: Adventist Health Commercial |
$488.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$655.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$700.06
|
| Rate for Payer: Blue Shield of California Commercial |
$921.42
|
| Rate for Payer: Blue Shield of California EPN |
$600.77
|
| Rate for Payer: Cash Price |
$655.60
|
| Rate for Payer: Cash Price |
$655.60
|
| Rate for Payer: Central Health Plan Commercial |
$953.60
|
| Rate for Payer: Cigna of CA HMO |
$834.40
|
| Rate for Payer: Cigna of CA PPO |
$834.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,013.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,013.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Senior |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,072.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.04
|
| Rate for Payer: InnovAge PACE Commercial |
$596.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$737.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$834.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$834.40
|
| Rate for Payer: Multiplan Commercial |
$894.00
|
| Rate for Payer: Networks By Design Commercial |
$596.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: Riverside University Health System MISP |
$476.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Other HMO |
$435.44
|
| Rate for Payer: United Healthcare HMO Rider |
$426.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,013.20
|
|
