|
HC KAFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
915352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| 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: 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
905352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| 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: 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC KAFO FX SEMI-RIGID
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT L2134
|
| Hospital Charge Code |
915352134
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$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
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
915352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.41 |
| Max. Negotiated Rate |
$951.20 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.43
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$861.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$951.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Riverside University Health System MISP |
$406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
905352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
905352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.41 |
| Max. Negotiated Rate |
$951.20 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.43
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$861.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$951.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Riverside University Health System MISP |
$406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC KAFO FX SOFT FITTED
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2132
|
| Hospital Charge Code |
915352132
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC KAFO, LIVELY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,970.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.33
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
|
|
HC KAFO, LIVELY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$804.67 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Adventist Health Commercial |
$1,007.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,429.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,970.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.33
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,396.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,542.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Riverside University Health System MISP |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC KAFO, LIVELY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
915352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$804.67 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Adventist Health Commercial |
$1,007.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,429.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,970.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.33
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,396.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,542.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Riverside University Health System MISP |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC KAFO, LIVELY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
915352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,970.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.33
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$922.11
|
| Rate for Payer: United Healthcare All Other HMO |
$897.54
|
| Rate for Payer: United Healthcare HMO Rider |
$878.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.67
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,171.47 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$1,466.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,682.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,080.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,040.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,271.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,110.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,503.90
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,430.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,271.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,110.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.40
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$2,325.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,271.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,110.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.40
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$2,325.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,171.47 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$1,466.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,682.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,080.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,040.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,271.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,110.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,503.90
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,430.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,132.17 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,010.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,772.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,039.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,382.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,772.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,039.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.40
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$2,247.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,132.17 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,010.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,772.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,039.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,382.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,772.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,039.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.40
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$2,247.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
905352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,142.20 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$1,142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,580.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,626.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,369.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.20
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$3,712.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
915352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,142.20 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$1,142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,580.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,626.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,369.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.20
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$3,712.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
915352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,400.79 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$2,341.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,141.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,322.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,580.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,854.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,854.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,400.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,626.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,547.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,369.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,997.70
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$2,855.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,854.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
905352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,400.79 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$2,341.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,141.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,322.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,580.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,854.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,854.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,400.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,626.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,547.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,369.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,997.70
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$2,855.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,854.35
|
|
|
HC KAFO SINGLE UPRIGHT NO KNEE
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
915352010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC KAFO SINGLE UPRIGHT NO KNEE
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
915352010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,276.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,410.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
