|
HC AFO FLOOR REACTION
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$1,791.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,062.66
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,592.00
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,791.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$758.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.00
|
| Rate for Payer: Multiplan Commercial |
$1,492.50
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.42
|
| Rate for Payer: United Healthcare All Other HMO |
$733.91
|
| Rate for Payer: United Healthcare HMO Rider |
$717.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$656.70
|
|
|
HC AFO FX RIGID
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$740.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.92
|
| Rate for Payer: Blue Distinction Transplant |
$918.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.50
|
| Rate for Payer: Blue Shield of California EPN |
$832.32
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Media |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,147.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.30
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC AFO FX RIGID
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT L2116
|
| Hospital Charge Code |
905352116
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Blue Shield of California EPN |
$817.02
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$577.73
|
| Rate for Payer: United Healthcare All Other HMO |
$564.26
|
| Rate for Payer: United Healthcare HMO Rider |
$552.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.90
|
|
|
HC AFO GAUNTLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.62
|
| Rate for Payer: Blue Distinction Transplant |
$103.20
|
| Rate for Payer: Blue Shield of California Commercial |
$129.00
|
| Rate for Payer: Blue Shield of California EPN |
$93.57
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.20
|
| Rate for Payer: Dignity Health Media |
$146.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.52
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Riverside University Health System MISP |
$68.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.00
|
| Rate for Payer: United Healthcare All Other HMO |
$86.00
|
| Rate for Payer: United Healthcare HMO Rider |
$86.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.20
|
| Rate for Payer: Vantage Medical Group Senior |
$146.20
|
|
|
HC AFO GAUNTLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
905351902
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Blue Shield of California EPN |
$91.85
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$120.40
|
| Rate for Payer: Cigna of CA PPO |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$86.00
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.95
|
| Rate for Payer: United Healthcare All Other HMO |
$63.43
|
| Rate for Payer: United Healthcare HMO Rider |
$62.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.76
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Blue Shield of California EPN |
$504.10
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.45
|
| Rate for Payer: United Healthcare All Other HMO |
$348.15
|
| Rate for Payer: United Healthcare HMO Rider |
$340.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.52
|
|
|
HC AFO MOLDED GAUNTLET
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT L1904
|
| Hospital Charge Code |
905351904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$330.40 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$519.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$457.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.72
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$708.00
|
| Rate for Payer: Blue Shield of California EPN |
$513.54
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$660.80
|
| Rate for Payer: Cigna of CA PPO |
$660.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Media |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.04
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$472.00
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Riverside University Health System MISP |
$377.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$472.00
|
| Rate for Payer: United Healthcare HMO Rider |
$472.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Blue Shield of California EPN |
$567.64
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$401.39
|
| Rate for Payer: United Healthcare All Other HMO |
$392.03
|
| Rate for Payer: United Healthcare HMO Rider |
$383.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$350.79
|
|
|
HC AFO MOLDED TO PT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT L1940
|
| Hospital Charge Code |
905351940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.05 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$903.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$584.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$514.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$628.02
|
| Rate for Payer: Blue Distinction Transplant |
$637.80
|
| Rate for Payer: Blue Shield of California Commercial |
$797.25
|
| Rate for Payer: Blue Shield of California EPN |
$578.27
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$744.10
|
| Rate for Payer: Cigna of CA PPO |
$744.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$903.55
|
| Rate for Payer: Dignity Health Media |
$903.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$903.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$797.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.83
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$531.50
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$531.50
|
| Rate for Payer: United Healthcare HMO Rider |
$531.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$531.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$903.55
|
| Rate for Payer: Vantage Medical Group Senior |
$903.55
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC AFO MULTILIGAMENTUS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
905351906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.85 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.16
|
| Rate for Payer: Blue Distinction Transplant |
$354.60
|
| Rate for Payer: Blue Shield of California Commercial |
$443.25
|
| Rate for Payer: Blue Shield of California EPN |
$321.50
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Media |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$443.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.31
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Riverside University Health System MISP |
$236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.50
|
| Rate for Payer: United Healthcare All Other HMO |
$295.50
|
| Rate for Payer: United Healthcare HMO Rider |
$295.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC AFO PHELPS TYPE
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT L1920
|
| Hospital Charge Code |
905351920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Blue Shield of California EPN |
$315.59
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$413.70
|
| Rate for Payer: Cigna of CA PPO |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.20
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$295.50
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.16
|
| Rate for Payer: United Healthcare All Other HMO |
$217.96
|
| Rate for Payer: United Healthcare HMO Rider |
$213.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.03
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$685.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$603.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$736.14
|
| Rate for Payer: Blue Distinction Transplant |
$747.60
|
| Rate for Payer: Blue Shield of California Commercial |
$934.50
|
| Rate for Payer: Blue Shield of California EPN |
$677.82
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.10
|
| Rate for Payer: Dignity Health Media |
$1,059.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$934.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$436.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.86
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: Riverside University Health System MISP |
$498.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.00
|
| Rate for Payer: United Healthcare All Other HMO |
$623.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.10
|
|
|
HC AFO PLASTIC ARTICULATED
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT L1970
|
| Hospital Charge Code |
905351970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$1,121.40 |
| Rate for Payer: Blue Shield of California EPN |
$665.36
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Central Health Plan Commercial |
$996.80
|
| Rate for Payer: Cigna of CA HMO |
$872.20
|
| Rate for Payer: Cigna of CA PPO |
$872.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.40
|
| Rate for Payer: Galaxy Health WC |
$1,059.10
|
| Rate for Payer: Global Benefits Group Commercial |
$747.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.20
|
| Rate for Payer: Multiplan Commercial |
$934.50
|
| Rate for Payer: Networks By Design Commercial |
$623.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.49
|
| Rate for Payer: United Healthcare All Other HMO |
$459.52
|
| Rate for Payer: United Healthcare HMO Rider |
$449.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.18
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
905351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$1,072.80 |
| Rate for Payer: Blue Shield of California EPN |
$636.53
|
| Rate for Payer: Cash Price |
$536.40
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$238.40
|
| 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: United Healthcare All Other Commercial |
$450.10
|
| Rate for Payer: United Healthcare All Other HMO |
$439.61
|
| Rate for Payer: United Healthcare HMO Rider |
$430.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.36
|
|
|
HC AFO POSTERIOR SOLID ANKLE
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT L1960
|
| Hospital Charge Code |
905351960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$417.20 |
| Max. Negotiated Rate |
$1,072.80 |
| 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 |
$655.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$577.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$704.23
|
| Rate for Payer: Blue Distinction Transplant |
$715.20
|
| Rate for Payer: Blue Shield of California Commercial |
$894.00
|
| Rate for Payer: Blue Shield of California EPN |
$648.45
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| 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 Media |
$1,013.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,013.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$894.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$417.20
|
| 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: LLUH Dept of Risk Management WC |
$488.72
|
| 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 |
$596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$596.00
|
| Rate for Payer: United Healthcare HMO Rider |
$596.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,013.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,013.20
|
|
|
HC AFO POST, SINGLE BAR
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L1910
|
| Hospital Charge Code |
905351910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$439.20 |
| 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 |
$268.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.31
|
| Rate for Payer: Blue Distinction Transplant |
$292.80
|
| Rate for Payer: Blue Shield of California Commercial |
$366.00
|
| Rate for Payer: Blue Shield of California EPN |
$265.47
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| 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 Media |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$366.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| 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 |
$244.00
|
| Rate for Payer: United Healthcare All Other HMO |
$244.00
|
| Rate for Payer: United Healthcare HMO Rider |
$244.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.00
|
| 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
|
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: Blue Shield of California EPN |
$260.59
|
| Rate for Payer: Cash Price |
$219.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$97.60
|
| 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: United Healthcare All Other Commercial |
$184.27
|
| Rate for Payer: United Healthcare All Other HMO |
$179.97
|
| Rate for Payer: United Healthcare HMO Rider |
$176.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.04
|
|
|
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 |
$613.20 |
| Max. Negotiated Rate |
$1,576.80 |
| 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 |
$963.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$848.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,035.08
|
| Rate for Payer: Blue Distinction Transplant |
$1,051.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,314.00
|
| Rate for Payer: Blue Shield of California EPN |
$953.09
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| 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 Media |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,314.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$613.20
|
| 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: LLUH Dept of Risk Management WC |
$718.32
|
| 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 |
$876.00
|
| Rate for Payer: United Healthcare All Other HMO |
$876.00
|
| Rate for Payer: United Healthcare HMO Rider |
$876.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$876.00
|
| 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: Blue Shield of California EPN |
$935.57
|
| Rate for Payer: Cash Price |
$788.40
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$350.40
|
| 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: United Healthcare All Other Commercial |
$661.56
|
| Rate for Payer: United Healthcare All Other HMO |
$646.14
|
| Rate for Payer: United Healthcare HMO Rider |
$632.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$578.16
|
|
|
HC AFO SINGLE UPRIGHT BK
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT L1980
|
| Hospital Charge Code |
905351980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.10 |
| Max. Negotiated Rate |
$689.40 |
| 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 |
$421.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$370.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.55
|
| Rate for Payer: Blue Distinction Transplant |
$459.60
|
| Rate for Payer: Blue Shield of California Commercial |
$574.50
|
| Rate for Payer: Blue Shield of California EPN |
$416.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| 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 Media |
$651.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$651.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$574.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.10
|
| 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: LLUH Dept of Risk Management WC |
$314.06
|
| 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 |
$383.00
|
| Rate for Payer: United Healthcare All Other HMO |
$383.00
|
| Rate for Payer: United Healthcare HMO Rider |
$383.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$383.00
|
| 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: Blue Shield of California EPN |
$409.04
|
| Rate for Payer: Cash Price |
$344.70
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$153.20
|
| 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: United Healthcare All Other Commercial |
$289.24
|
| Rate for Payer: United Healthcare All Other HMO |
$282.50
|
| Rate for Payer: United Healthcare HMO Rider |
$276.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.78
|
|
|
HC AFO SMO CUSTOM FABRICATED
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L1907
|
| Hospital Charge Code |
905351907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.45 |
| Max. Negotiated Rate |
$852.30 |
| 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 |
$520.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$458.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.49
|
| Rate for Payer: Blue Distinction Transplant |
$568.20
|
| Rate for Payer: Blue Shield of California Commercial |
$710.25
|
| Rate for Payer: Blue Shield of California EPN |
$515.17
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| 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 Media |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$710.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.45
|
| 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: LLUH Dept of Risk Management WC |
$388.27
|
| 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 |
$473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$473.50
|
| Rate for Payer: United Healthcare HMO Rider |
$473.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$473.50
|
| 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: Blue Shield of California EPN |
$505.70
|
| Rate for Payer: Cash Price |
$426.15
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$189.40
|
| 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: United Healthcare All Other Commercial |
$357.59
|
| Rate for Payer: United Healthcare All Other HMO |
$349.25
|
| Rate for Payer: United Healthcare HMO Rider |
$341.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$312.51
|
|
