|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.05
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.05
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20.05
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20.05
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,332.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,360.76 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,416.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,332.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,592.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,662.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,360.76 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,416.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,332.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,592.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,662.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,332.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,415.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$713.29 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,266.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Riverside University Health System MISP |
$871.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$713.29 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,266.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Riverside University Health System MISP |
$871.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,415.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.02 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,689.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,464.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,705.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,755.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,305.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,464.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,755.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,612.20
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.02 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,689.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,464.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,705.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,755.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,305.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,464.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,755.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,612.20
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
915352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.96
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.96
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$550.86 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$689.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.96
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,136.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,255.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$689.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Riverside University Health System MISP |
$672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
915352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$550.86 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$689.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.96
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,136.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,255.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$689.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Riverside University Health System MISP |
$672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
|
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 |
$1,261.86 |
| Max. Negotiated Rate |
$3,467.70 |
| 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 |
$2,241.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,941.91
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,412.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,446.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,273.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,697.10
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,541.20
|
| 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
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
905352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$3,467.70 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,941.91
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,446.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,273.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.60
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$2,504.45
|
| 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 |
$1,261.86 |
| Max. Negotiated Rate |
$3,467.70 |
| 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 |
$2,241.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,941.91
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,412.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,446.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,273.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,697.10
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,541.20
|
| 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
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
915352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$3,467.70 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,941.91
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,446.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,273.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.60
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$2,504.45
|
| 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 SEMI-RIGID
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
905352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$1,296.00 |
| 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 |
$837.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,154.88
|
| Rate for Payer: Blue Shield of California EPN |
$725.76
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,296.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,107.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,223.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Riverside University Health System MISP |
$576.00
|
| 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
|
|
