|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.40
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$2,325.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,171.47 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$1,466.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,682.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,100.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,040.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: InnovAge PACE Commercial |
$1,788.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,503.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,503.90
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$1,788.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,430.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
915352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$3,219.30 |
| Rate for Payer: Adventist Health Commercial |
$715.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.81
|
| Rate for Payer: Cash Price |
$1,609.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,861.60
|
| Rate for Payer: Cigna of CA HMO |
$2,503.90
|
| Rate for Payer: Cigna of CA PPO |
$2,503.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,430.80
|
| Rate for Payer: Galaxy Health WC |
$3,040.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,219.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,385.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.40
|
| Rate for Payer: Multiplan Commercial |
$2,682.75
|
| Rate for Payer: Networks By Design Commercial |
$2,325.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,040.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,342.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,306.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,171.47
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,132.17 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,030.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,672.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: InnovAge PACE Commercial |
$1,728.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,419.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,382.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,132.17 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$1,417.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,592.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,030.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,672.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,938.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,622.17
|
| Rate for Payer: InnovAge PACE Commercial |
$1,728.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,419.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,419.90
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$1,728.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,382.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,938.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,938.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,672.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.40
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$2,247.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
IP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
915352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$3,111.30 |
| Rate for Payer: Adventist Health Commercial |
$691.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,672.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.33
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,765.60
|
| Rate for Payer: Cigna of CA HMO |
$2,419.90
|
| Rate for Payer: Cigna of CA PPO |
$2,419.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,382.80
|
| Rate for Payer: Galaxy Health WC |
$2,938.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,111.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,139.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.40
|
| Rate for Payer: Multiplan Commercial |
$2,592.75
|
| Rate for Payer: Networks By Design Commercial |
$2,247.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,938.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,132.17
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
905352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,142.20 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$1,142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,414.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,175.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,535.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.20
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$3,712.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
905352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,400.79 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$2,341.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,141.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,354.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,414.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,854.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,854.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,400.79
|
| Rate for Payer: InnovAge PACE Commercial |
$2,855.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,535.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,997.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,997.70
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$2,855.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,854.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
915352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,142.20 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$1,142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,414.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,175.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,535.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.20
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$3,712.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
|
|
HC KAFO SINGLE UPRIGHT AK
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
CPT L2000
|
| Hospital Charge Code |
915352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,400.79 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Adventist Health Commercial |
$2,341.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,141.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,354.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,414.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,878.34
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Cash Price |
$2,569.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,568.80
|
| Rate for Payer: Cigna of CA HMO |
$3,997.70
|
| Rate for Payer: Cigna of CA PPO |
$3,997.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,854.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,854.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.40
|
| Rate for Payer: Galaxy Health WC |
$4,854.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,139.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,400.79
|
| Rate for Payer: InnovAge PACE Commercial |
$2,855.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,535.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,997.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,997.70
|
| Rate for Payer: Multiplan Commercial |
$4,283.25
|
| Rate for Payer: Networks By Design Commercial |
$2,855.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,854.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2,086.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,870.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,854.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,854.35
|
|
|
HC KAFO SINGLE UPRIGHT NO KNEE
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
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 |
$1,536.72
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| 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 |
$1,167.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| 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: 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: InnovAge PACE Commercial |
$994.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,410.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.60
|
| Rate for Payer: Molina Healthcare of CA 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 NO KNEE
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
915352010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,167.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| 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: 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: InnovAge PACE Commercial |
$994.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,410.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.60
|
| Rate for Payer: Molina Healthcare of CA 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 NO KNEE
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L2010
|
| Hospital Charge Code |
915352010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| 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 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 |
$1,929.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,539.30
|
| 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: 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: InnovAge PACE Commercial |
$1,642.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,299.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| 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 |
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 |
$2,539.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$2,539.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$1,929.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,539.30
|
| 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: 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: InnovAge PACE Commercial |
$1,642.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,392.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,299.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,463.75
|
| 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 |
$4,372.09
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.20
|
| 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
|
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 |
$4,372.09
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.20
|
| 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 |
$3,321.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,372.09
|
| 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: 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: InnovAge PACE Commercial |
$2,828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,318.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,959.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| 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 |
$3,321.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,372.09
|
| 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: 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: InnovAge PACE Commercial |
$2,828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,501.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,318.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,959.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| 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 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 |
$159.75
|
| Rate for Payer: Blue Shield of California Commercial |
$210.26
|
| 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: 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: InnovAge PACE Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$210.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
|
