|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$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
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
905351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Blue Shield of California Commercial |
$385.73
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Blue Shield of California Commercial |
$385.73
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.42 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$204.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.06
|
| Rate for Payer: Blue Shield of California Commercial |
$385.73
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.64
|
| Rate for Payer: InnovAge PACE Commercial |
$249.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
905351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.42 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$204.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.06
|
| Rate for Payer: Blue Shield of California Commercial |
$385.73
|
| Rate for Payer: Blue Shield of California EPN |
$251.50
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.64
|
| Rate for Payer: InnovAge PACE Commercial |
$249.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$375.68
|
| Rate for Payer: Blue Shield of California EPN |
$244.94
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$315.90
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Adventist Health Commercial |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.43
|
| Rate for Payer: Blue Shield of California Commercial |
$375.68
|
| Rate for Payer: Blue Shield of California EPN |
$244.94
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: InnovAge PACE Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Riverside University Health System MISP |
$194.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Adventist Health Commercial |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.43
|
| Rate for Payer: Blue Shield of California Commercial |
$375.68
|
| Rate for Payer: Blue Shield of California EPN |
$244.94
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: InnovAge PACE Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Riverside University Health System MISP |
$194.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$375.68
|
| Rate for Payer: Blue Shield of California EPN |
$244.94
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$315.90
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.89
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.89
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.27
|
| Rate for Payer: Blue Shield of California Commercial |
$214.89
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: InnovAge PACE Commercial |
$139.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Riverside University Health System MISP |
$111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.27
|
| Rate for Payer: Blue Shield of California Commercial |
$214.89
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| Rate for Payer: InnovAge PACE Commercial |
$139.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Riverside University Health System MISP |
$111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
905354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,314.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,633.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.57
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,787.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
OP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,404.27 |
| Max. Negotiated Rate |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$1,758.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,358.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,215.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,518.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,314.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,644.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,644.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,286.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2,143.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,001.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,715.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,572.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,572.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3,644.67
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,314.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,633.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.57
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,787.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
OP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
905354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,404.27 |
| Max. Negotiated Rate |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$1,758.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,358.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,215.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,518.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,314.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Cash Price |
$2,358.32
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,644.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,644.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,286.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2,143.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,001.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,715.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,572.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,572.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3,644.67
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$569.70
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$569.70
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.37 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$302.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.84
|
| Rate for Payer: Blue Shield of California Commercial |
$569.70
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$506.78
|
| Rate for Payer: InnovAge PACE Commercial |
$368.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.37 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$302.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.84
|
| Rate for Payer: Blue Shield of California Commercial |
$569.70
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$506.78
|
| Rate for Payer: InnovAge PACE Commercial |
$368.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.60 |
| Max. Negotiated Rate |
$2,779.20 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Cash Price |
$1,698.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,470.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.20
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,779.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,176.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,911.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,698.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,886.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.11
|
| Rate for Payer: Cash Price |
$1,698.40
|
| Rate for Payer: Cash Price |
$1,698.40
|
| Rate for Payer: Cash Price |
$1,698.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,470.40
|
| Rate for Payer: Cigna of CA HMO |
$1,976.32
|
| Rate for Payer: Cigna of CA PPO |
$2,285.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,624.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,624.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.20
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,779.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,544.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,911.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,161.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,235.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,852.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,544.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,544.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,544.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,544.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,624.80
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$7,709.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,541.80 |
| Max. Negotiated Rate |
$6,938.10 |
| Rate for Payer: Adventist Health Commercial |
$1,541.80
|
| Rate for Payer: Cash Price |
$4,239.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,083.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,083.60
|
| Rate for Payer: Galaxy Health WC |
$6,552.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,625.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,938.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,937.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.80
|
| Rate for Payer: Multiplan Commercial |
$5,781.75
|
| Rate for Payer: Networks By Design Commercial |
$5,010.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,552.65
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$7,709.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$14,424.93 |
| Rate for Payer: Adventist Health Commercial |
$1,541.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$8,795.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,075.89
|
| Rate for Payer: Cash Price |
$4,239.95
|
| Rate for Payer: Cash Price |
$4,239.95
|
| Rate for Payer: Cash Price |
$4,239.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,167.20
|
| Rate for Payer: Cigna of CA HMO |
$4,933.76
|
| Rate for Payer: Cigna of CA PPO |
$5,704.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$6,552.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,625.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,938.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: InnovAge PACE Commercial |
$13,193.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,786.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$5,781.75
|
| Rate for Payer: Networks By Design Commercial |
$5,010.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Prime Health Services Commercial |
$6,552.65
|
| Rate for Payer: Prime Health Services Medicare |
$9,323.43
|
| Rate for Payer: Riverside University Health System MISP |
$9,675.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,625.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,625.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,854.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,854.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,854.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,854.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
