|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$110.79 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.48
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903207680
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903200166
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903207680
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Adventist Health Commercial |
$331.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: InnovAge PACE Commercial |
$404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Riverside University Health System MISP |
$323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903200166
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Adventist Health Commercial |
$331.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Cash Price |
$444.40
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: InnovAge PACE Commercial |
$404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Riverside University Health System MISP |
$323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.08
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,062.05
|
| Rate for Payer: Cash Price |
$1,062.05
|
| Rate for Payer: Cash Price |
$1,062.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.80
|
| Rate for Payer: Cigna of CA HMO |
$1,235.84
|
| Rate for Payer: Cigna of CA PPO |
$1,428.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,641.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,255.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,641.35
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.20 |
| Max. Negotiated Rate |
$1,737.90 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Cash Price |
$1,062.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.40
|
| Rate for Payer: EPIC Health Plan Senior |
$772.40
|
| Rate for Payer: Galaxy Health WC |
$1,641.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.20
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: Networks By Design Commercial |
$1,255.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,641.35
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,360.76 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,440.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,592.57
|
| Rate for Payer: InnovAge PACE Commercial |
$2,077.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,662.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,360.76 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,440.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.12
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Cash Price |
$2,285.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,739.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,592.57
|
| Rate for Payer: InnovAge PACE Commercial |
$2,077.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,771.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,571.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,116.25
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,662.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,415.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$713.29 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,089.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Riverside University Health System MISP |
$871.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$713.29 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$892.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,089.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,431.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,089.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: Riverside University Health System MISP |
$871.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
915352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,960.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,633.50
|
| Rate for Payer: Networks By Design Commercial |
$1,415.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.02 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,734.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,705.02
|
| Rate for Payer: InnovAge PACE Commercial |
$4,030.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,305.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,642.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,612.20
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX MOLDED
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,612.20 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$1,612.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,612.20
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
915352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.02 |
| Max. Negotiated Rate |
$7,254.90 |
| Rate for Payer: Adventist Health Commercial |
$3,305.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,433.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,045.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,734.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,062.74
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Cash Price |
$4,433.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,254.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,705.02
|
| Rate for Payer: InnovAge PACE Commercial |
$4,030.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,883.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,989.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,305.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,642.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$6,045.75
|
| Rate for Payer: Networks By Design Commercial |
$4,030.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,836.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2,944.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,851.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,851.85
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
915352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.19
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
915352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$550.86 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$689.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$987.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.19
|
| Rate for Payer: Blue Shield of California EPN |
$847.73
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,136.89
|
| Rate for Payer: InnovAge PACE Commercial |
$841.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$689.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$841.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Riverside University Health System MISP |
$672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.25
|
| Rate for Payer: United Healthcare All Other HMO |
$614.43
|
| Rate for Payer: United Healthcare HMO Rider |
$601.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
