|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$29.44
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,212.95 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$570.80
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$951.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$883.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cigna of CA HMO |
$913.28
|
| Rate for Payer: Cigna of CA PPO |
$1,055.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$951.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,583.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$3,531.75 |
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,406.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,066.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,019.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,555.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,583.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$3,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,406.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,066.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,019.33
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,555.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.72 |
| Max. Negotiated Rate |
$1,851.30 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,261.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,058.51
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,265.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$829.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.72
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$829.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.72
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.72 |
| Max. Negotiated Rate |
$1,851.30 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,261.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,058.51
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,265.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,665.37 |
| Max. Negotiated Rate |
$6,851.85 |
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,668.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5,949.02
|
| Rate for Payer: Blue Shield of California EPN |
$3,917.65
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,665.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,642.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,071.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,665.37 |
| Max. Negotiated Rate |
$6,851.85 |
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,668.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5,949.02
|
| Rate for Payer: Blue Shield of California EPN |
$3,917.65
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,665.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,642.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,071.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
915352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$1,345.60
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$1,345.60
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.68 |
| Max. Negotiated Rate |
$1,429.70 |
| Rate for Payer: Adventist Health Commercial |
$689.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.32
|
| Rate for Payer: Blue Shield of California EPN |
$817.45
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,110.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,255.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,345.60
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
