|
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 Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.84
|
| Rate for Payer: Kaiser Permanente of CA 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 RIGID FITTED
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
915352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,446.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,261.86
|
|
|
HC KAFO FX RIGID FITTED
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
905352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,446.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,261.86
|
|
|
HC KAFO FX RIGID FITTED
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
915352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.72 |
| Max. Negotiated Rate |
$3,275.05 |
| Rate for Payer: Adventist Health Commercial |
$1,579.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,119.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,889.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,231.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,843.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.56
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,275.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,275.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,697.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,697.10
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,446.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,261.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,275.05
|
|
|
HC KAFO FX RIGID FITTED
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
905352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.72 |
| Max. Negotiated Rate |
$3,275.05 |
| Rate for Payer: Adventist Health Commercial |
$1,579.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,119.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,889.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,231.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,843.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.56
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,275.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,275.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,697.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,697.10
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,446.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,261.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,275.05
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
905352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$590.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.72
|
| Rate for Payer: Blue Shield of California EPN |
$699.84
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,081.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,223.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
915352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
905352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
915352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$590.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.72
|
| Rate for Payer: Blue Shield of California EPN |
$699.84
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,081.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,223.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
905352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
915352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$951.20 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$749.07
|
| Rate for Payer: Blue Shield of California EPN |
$493.29
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$841.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
915352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
905352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$951.20 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$749.07
|
| Rate for Payer: Blue Shield of California EPN |
$493.29
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$841.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC KAFO, LIVELY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Adventist Health Commercial |
$1,007.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,423.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,813.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,194.10
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,363.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,719.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC KAFO, LIVELY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
915352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
|
|
HC KAFO, LIVELY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
915352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Adventist Health Commercial |
$1,007.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,423.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,813.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,194.10
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,363.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,719.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC KAFO, LIVELY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$858.48 |
| Max. Negotiated Rate |
$3,040.45 |
| Rate for Payer: Adventist Health Commercial |
$1,466.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,682.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,071.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,639.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.42
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,040.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,503.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,503.90
|
| Rate for Payer: Multiplan Commercial |
$2,861.60
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$858.48 |
| Max. Negotiated Rate |
$3,040.45 |
| Rate for Payer: Adventist Health Commercial |
$1,466.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,682.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,071.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,639.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.42
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,040.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,503.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,503.90
|
| Rate for Payer: Multiplan Commercial |
$2,861.60
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.48
|
| Rate for Payer: Multiplan Commercial |
$2,861.60
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.48
|
| Rate for Payer: Multiplan Commercial |
$2,861.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$829.68 |
| Max. Negotiated Rate |
$2,938.45 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,002.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,551.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,680.10
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,419.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.68
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.68
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$829.68 |
| Max. Negotiated Rate |
$2,938.45 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,002.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,551.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,680.10
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,584.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,419.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
