|
HC KAFO SINGLE UPRIGHT NO KNEE
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
905352010
|
|
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 |
905352010
|
|
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
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
905352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Adventist Health Commercial |
$657.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,655.64
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,956.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,085.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| Rate for Payer: Networks By Design Commercial |
$2,135.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
915352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.84 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Adventist Health Commercial |
$1,346.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,806.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,463.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,910.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,655.64
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,792.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,792.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,956.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,166.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,085.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,971.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,792.25
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
915352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Adventist Health Commercial |
$657.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,655.64
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,956.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,085.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| Rate for Payer: Networks By Design Commercial |
$2,135.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
905352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.84 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Adventist Health Commercial |
$1,346.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,806.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,463.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,910.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,655.64
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Cash Price |
$1,478.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,299.50
|
| Rate for Payer: Cigna of CA PPO |
$2,299.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,792.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,792.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.00
|
| Rate for Payer: Galaxy Health WC |
$2,792.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,956.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,166.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,085.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| Rate for Payer: Networks By Design Commercial |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,971.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,232.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,075.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,792.25
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
915352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Adventist Health Commercial |
$1,131.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,850.62
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,591.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$3,676.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
915352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,852.34 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Adventist Health Commercial |
$2,318.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,242.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,290.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,850.62
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,807.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,430.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,591.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,318.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,262.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,852.34 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Adventist Health Commercial |
$2,318.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,242.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,290.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,850.62
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,807.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,430.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,591.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,318.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,262.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Adventist Health Commercial |
$1,131.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,850.62
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,591.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$3,676.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Blue Shield of California Commercial |
$218.14
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Blue Shield of California Commercial |
$218.14
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.22
|
| Rate for Payer: Blue Shield of California Commercial |
$218.14
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Riverside University Health System MISP |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.22
|
| Rate for Payer: Blue Shield of California Commercial |
$218.14
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Riverside University Health System MISP |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$570.22
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.85 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.59
|
| Rate for Payer: Blue Shield of California Commercial |
$570.22
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$692.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Riverside University Health System MISP |
$284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.85 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.59
|
| Rate for Payer: Blue Shield of California Commercial |
$570.22
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$692.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Riverside University Health System MISP |
$284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$570.22
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Blue Shield of California Commercial |
$997.69
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Blue Shield of California Commercial |
$997.69
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.31 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$723.63
|
| Rate for Payer: Blue Shield of California Commercial |
$997.69
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Riverside University Health System MISP |
$497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.31 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$723.63
|
| Rate for Payer: Blue Shield of California Commercial |
$997.69
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Riverside University Health System MISP |
$497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
