|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
915351960
|
|
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
|
|
|
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 POST, SINGLE BAR
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
915351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
905351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
915351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.47
|
| Rate for Payer: InnovAge PACE Commercial |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Riverside University Health System MISP |
$195.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
905351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.47
|
| Rate for Payer: InnovAge PACE Commercial |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Riverside University Health System MISP |
$195.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
915351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$1,576.80 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.30
|
| Rate for Payer: Blue Shield of California EPN |
$883.01
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,401.60
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,576.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$1,314.00
|
| Rate for Payer: Networks By Design Commercial |
$1,138.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
905351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$573.78 |
| Max. Negotiated Rate |
$1,576.80 |
| Rate for Payer: Adventist Health Commercial |
$718.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,314.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,028.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.30
|
| Rate for Payer: Blue Shield of California EPN |
$883.01
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,401.60
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,576.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$964.82
|
| Rate for Payer: InnovAge PACE Commercial |
$876.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,226.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,226.40
|
| Rate for Payer: Multiplan Commercial |
$1,314.00
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: Riverside University Health System MISP |
$700.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,489.20
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
915351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$573.78 |
| Max. Negotiated Rate |
$1,576.80 |
| Rate for Payer: Adventist Health Commercial |
$718.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,314.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,028.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.30
|
| Rate for Payer: Blue Shield of California EPN |
$883.01
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,401.60
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,576.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$964.82
|
| Rate for Payer: InnovAge PACE Commercial |
$876.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,226.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,226.40
|
| Rate for Payer: Multiplan Commercial |
$1,314.00
|
| Rate for Payer: Networks By Design Commercial |
$876.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: Riverside University Health System MISP |
$700.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,489.20
|
|
|
HC AFO RIG ANT TIB PREFAB TCF/=
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT L1932
|
| Hospital Charge Code |
905351932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$1,576.80 |
| Rate for Payer: Adventist Health Commercial |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.30
|
| Rate for Payer: Blue Shield of California EPN |
$883.01
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,401.60
|
| Rate for Payer: Cigna of CA HMO |
$1,226.40
|
| Rate for Payer: Cigna of CA PPO |
$1,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,576.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,084.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$1,314.00
|
| Rate for Payer: Networks By Design Commercial |
$1,138.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.53
|
| Rate for Payer: United Healthcare All Other HMO |
$640.01
|
| Rate for Payer: United Healthcare HMO Rider |
$626.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.78
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
915351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$592.12
|
| Rate for Payer: Blue Shield of California EPN |
$386.06
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.87 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Adventist Health Commercial |
$314.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$421.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.87
|
| Rate for Payer: Blue Shield of California Commercial |
$592.12
|
| Rate for Payer: Blue Shield of California EPN |
$386.06
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$651.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$651.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$651.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.34
|
| Rate for Payer: InnovAge PACE Commercial |
$383.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$536.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$536.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: Riverside University Health System MISP |
$306.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$651.10
|
| Rate for Payer: Vantage Medical Group Senior |
$651.10
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$592.12
|
| Rate for Payer: Blue Shield of California EPN |
$386.06
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
915351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.87 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Adventist Health Commercial |
$314.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$421.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.87
|
| Rate for Payer: Blue Shield of California Commercial |
$592.12
|
| Rate for Payer: Blue Shield of California EPN |
$386.06
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Cash Price |
$421.30
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Cigna of CA HMO |
$536.20
|
| Rate for Payer: Cigna of CA PPO |
$536.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$651.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$651.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$651.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.34
|
| Rate for Payer: InnovAge PACE Commercial |
$383.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$474.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$536.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$536.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$383.00
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: Riverside University Health System MISP |
$306.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.48
|
| Rate for Payer: United Healthcare All Other HMO |
$279.82
|
| Rate for Payer: United Healthcare HMO Rider |
$273.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$651.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$651.10
|
| Rate for Payer: Vantage Medical Group Senior |
$651.10
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
915351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.14 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.17
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$608.38
|
| Rate for Payer: InnovAge PACE Commercial |
$473.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Riverside University Health System MISP |
$378.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
905351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.40
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$615.55
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
905351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.14 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.17
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$608.38
|
| Rate for Payer: InnovAge PACE Commercial |
$473.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Riverside University Health System MISP |
$378.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
915351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.40
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$615.55
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
915351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,238.35
|
| Rate for Payer: Blue Shield of California EPN |
$807.41
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$1,041.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
915351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$524.65 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Adventist Health Commercial |
$656.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,201.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$940.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,238.35
|
| Rate for Payer: Blue Shield of California EPN |
$807.41
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,361.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$752.47
|
| Rate for Payer: InnovAge PACE Commercial |
$801.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,121.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,121.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: Riverside University Health System MISP |
$640.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,361.70
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,238.35
|
| Rate for Payer: Blue Shield of California EPN |
$807.41
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$1,041.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$524.65 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Adventist Health Commercial |
$656.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,201.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$940.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,238.35
|
| Rate for Payer: Blue Shield of California EPN |
$807.41
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,361.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$752.47
|
| Rate for Payer: InnovAge PACE Commercial |
$801.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,121.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,121.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: Riverside University Health System MISP |
$640.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.23
|
| Rate for Payer: United Healthcare All Other HMO |
$585.21
|
| Rate for Payer: United Healthcare HMO Rider |
$572.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,361.70
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.08 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,093.02
|
| Rate for Payer: Blue Shield of California EPN |
$712.66
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$908.04
|
| Rate for Payer: InnovAge PACE Commercial |
$707.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Riverside University Health System MISP |
$565.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
915351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.08 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Adventist Health Commercial |
$579.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,093.02
|
| Rate for Payer: Blue Shield of California EPN |
$712.66
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$908.04
|
| Rate for Payer: InnovAge PACE Commercial |
$707.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Riverside University Health System MISP |
$565.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
915351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,093.02
|
| Rate for Payer: Blue Shield of California EPN |
$712.66
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.67
|
| Rate for Payer: United Healthcare All Other HMO |
$516.53
|
| Rate for Payer: United Healthcare HMO Rider |
$505.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$463.08
|
|
