|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
915352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$788.40 |
| Max. Negotiated Rate |
$2,792.25 |
| Rate for Payer: Adventist Health Commercial |
$1,346.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,806.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,463.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,902.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,424.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.51
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,792.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,792.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,115.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,299.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,971.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,792.25
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
905352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$657.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.40
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
915352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$657.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.40
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
905352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$788.40 |
| Max. Negotiated Rate |
$2,792.25 |
| Rate for Payer: Adventist Health Commercial |
$1,346.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,806.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,463.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,902.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,424.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.51
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,792.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,792.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,115.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,299.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,971.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,792.25
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
915352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.44
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.44
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
915352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,357.44 |
| Max. Negotiated Rate |
$4,894.13 |
| Rate for Payer: Adventist Health Commercial |
$2,318.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,242.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,275.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,174.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,748.82
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,807.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,327.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,959.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,357.44 |
| Max. Negotiated Rate |
$4,894.13 |
| Rate for Payer: Adventist Health Commercial |
$2,318.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,242.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,275.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,174.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,748.82
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cash Price |
$3,110.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,807.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,327.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,959.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.54
|
| Rate for Payer: Blue Shield of California Commercial |
$200.74
|
| Rate for Payer: Blue Shield of California EPN |
$132.19
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.54
|
| Rate for Payer: Blue Shield of California Commercial |
$200.74
|
| Rate for Payer: Blue Shield of California EPN |
$132.19
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.81
|
| Rate for Payer: Blue Shield of California Commercial |
$524.72
|
| Rate for Payer: Blue Shield of California EPN |
$345.55
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.81
|
| Rate for Payer: Blue Shield of California Commercial |
$524.72
|
| Rate for Payer: Blue Shield of California EPN |
$345.55
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.93 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$720.52
|
| Rate for Payer: Blue Shield of California Commercial |
$918.07
|
| Rate for Payer: Blue Shield of California EPN |
$604.58
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.93 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$720.52
|
| Rate for Payer: Blue Shield of California Commercial |
$918.07
|
| Rate for Payer: Blue Shield of California EPN |
$604.58
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.16 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$555.45
|
| Rate for Payer: Blue Shield of California Commercial |
$707.74
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
