|
HC JOB SITE ASSESSMENT PT
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903207680
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$501.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$495.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$528.64
|
| Rate for Payer: Cigna of CA PPO |
$611.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Media |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$619.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.66
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Riverside University Health System MISP |
$330.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.00
|
| Rate for Payer: Galaxy Health WC |
$1,241.00
|
| Rate for Payer: Global Benefits Group Commercial |
$876.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,314.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Multiplan Commercial |
$1,095.00
|
| Rate for Payer: Networks By Design Commercial |
$949.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.00
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$876.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,168.00
|
| Rate for Payer: Cigna of CA PPO |
$1,080.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,241.00
|
| Rate for Payer: Global Benefits Group Commercial |
$876.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,314.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,095.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,095.00
|
| Rate for Payer: Networks By Design Commercial |
$949.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.00
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$876.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
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: Blue Shield of California EPN |
$2,218.77
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$2,771.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.06
|
| 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 |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,568.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,532.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1,499.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.15
|
|
|
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 |
$1,454.25 |
| Max. Negotiated Rate |
$3,739.50 |
| 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 |
$2,285.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,011.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,454.77
|
| Rate for Payer: Blue Distinction Transplant |
$2,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,116.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,260.32
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.00
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Media |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3,116.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,454.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,771.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,759.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.55
|
| 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 |
$2,077.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,077.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,077.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,077.50
|
| 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: Blue Shield of California EPN |
$1,163.05
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$435.60
|
| 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: United Healthcare All Other Commercial |
$822.41
|
| Rate for Payer: United Healthcare All Other HMO |
$803.25
|
| Rate for Payer: United Healthcare HMO Rider |
$785.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.74
|
|
|
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 |
$762.30 |
| Max. Negotiated Rate |
$1,960.20 |
| 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 |
$1,197.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,054.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,286.76
|
| Rate for Payer: Blue Distinction Transplant |
$1,306.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,633.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,184.83
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.40
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,851.30
|
| Rate for Payer: Dignity Health Media |
$1,851.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,633.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$762.30
|
| 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: LLUH Dept of Risk Management WC |
$892.98
|
| 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 |
$1,089.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,851.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,851.30
|
|
|
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: Blue Shield of California EPN |
$4,304.57
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$1,612.20
|
| 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: United Healthcare All Other Commercial |
$3,043.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2,972.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2,908.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,660.13
|
|
|
HC KAFO FX MOLDED
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT L2128
|
| Hospital Charge Code |
905352128
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,883.45 |
| Max. Negotiated Rate |
$7,254.90 |
| 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 |
$4,433.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,903.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,762.44
|
| Rate for Payer: Blue Distinction Transplant |
$4,836.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,045.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,385.18
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,448.80
|
| Rate for Payer: Cigna of CA HMO |
$5,642.70
|
| Rate for Payer: Cigna of CA PPO |
$5,642.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,851.85
|
| Rate for Payer: Dignity Health Media |
$6,851.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$6,045.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,821.35
|
| 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: LLUH Dept of Risk Management WC |
$3,305.01
|
| 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 |
$4,030.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,030.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,030.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,030.50
|
| 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
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$588.70 |
| Max. Negotiated Rate |
$1,513.80 |
| 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 |
$925.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$814.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$993.73
|
| Rate for Payer: Blue Distinction Transplant |
$1,009.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,261.50
|
| Rate for Payer: Blue Shield of California EPN |
$915.01
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Media |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,261.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$588.70
|
| 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: LLUH Dept of Risk Management WC |
$689.62
|
| 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 |
$841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
|
HC KAFO FX PLASTIC
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT L2126
|
| Hospital Charge Code |
905352126
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Blue Shield of California EPN |
$898.19
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,177.40
|
| Rate for Payer: Cigna of CA PPO |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$336.40
|
| 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: United Healthcare All Other Commercial |
$635.12
|
| Rate for Payer: United Healthcare All Other HMO |
$620.32
|
| Rate for Payer: United Healthcare HMO Rider |
$606.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$555.06
|
|
|
HC KAFO FX RIGID FITTED
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
905352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$3,467.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,057.50
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.60
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,454.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,420.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,390.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.49
|
|
|
HC KAFO FX RIGID FITTED
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
905352136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.55 |
| Max. Negotiated Rate |
$3,467.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,119.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,119.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,865.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,276.35
|
| Rate for Payer: Blue Distinction Transplant |
$2,311.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,889.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,096.03
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Cash Price |
$1,733.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,082.40
|
| Rate for Payer: Cigna of CA HMO |
$2,697.10
|
| Rate for Payer: Cigna of CA PPO |
$2,697.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Dignity Health Media |
$3,275.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,275.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,467.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,889.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,348.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.73
|
| Rate for Payer: Multiplan Commercial |
$2,889.75
|
| Rate for Payer: Networks By Design Commercial |
$1,926.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,541.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,926.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,926.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,926.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,275.05
|
|
|
HC KAFO, LIVELY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$859.95 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,351.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,189.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,451.60
|
| Rate for Payer: Blue Distinction Transplant |
$1,474.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,842.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,336.61
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Media |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,842.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.37
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Riverside University Health System MISP |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,228.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC KAFO, LIVELY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT L2038
|
| Hospital Charge Code |
905352038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,312.04
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,719.90
|
| Rate for Payer: Cigna of CA PPO |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,228.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$927.76
|
| Rate for Payer: United Healthcare All Other HMO |
$906.14
|
| Rate for Payer: United Healthcare HMO Rider |
$886.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.81
|
|
|
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: Blue Shield of California EPN |
$1,910.12
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$715.40
|
| 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: United Healthcare All Other Commercial |
$1,350.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,319.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,290.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,180.41
|
|
|
HC KAFO, PLASTIC DBL UPRIGHT
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
CPT L2036
|
| Hospital Charge Code |
905352036
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,251.95 |
| Max. Negotiated Rate |
$3,219.30 |
| 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 |
$1,967.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,731.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,113.29
|
| Rate for Payer: Blue Distinction Transplant |
$2,146.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,682.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,945.89
|
| 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 Media |
$3,040.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,040.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,682.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,251.95
|
| 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: LLUH Dept of Risk Management WC |
$1,466.57
|
| 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 |
$1,788.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,788.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,788.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,788.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,040.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,040.45
|
|
|
HC KAFO, PLASTIC SINGLE UPRIGHT
|
Facility
|
OP
|
$3,457.00
|
|
|
Service Code
|
CPT L2037
|
| Hospital Charge Code |
905352037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,209.95 |
| Max. Negotiated Rate |
$3,111.30 |
| 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 |
$1,901.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,673.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,042.40
|
| Rate for Payer: Blue Distinction Transplant |
$2,074.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,592.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,880.61
|
| 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 Media |
$2,938.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,938.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,592.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,209.95
|
| 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: LLUH Dept of Risk Management WC |
$1,417.37
|
| 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 |
$1,728.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,728.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,728.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.50
|
| 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: Blue Shield of California EPN |
$1,846.04
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$691.40
|
| 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: United Healthcare All Other Commercial |
$1,305.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,247.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,140.81
|
|
|
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 |
$1,547.38 |
| Max. Negotiated Rate |
$5,139.90 |
| 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 |
$3,141.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,765.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,374.06
|
| Rate for Payer: Blue Distinction Transplant |
$3,426.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,283.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,106.78
|
| 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 Media |
$4,854.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,854.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$4,283.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,998.85
|
| 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: LLUH Dept of Risk Management WC |
$2,341.51
|
| 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 |
$2,855.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,855.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,855.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,855.50
|
| 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 |
905352000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,142.20 |
| Max. Negotiated Rate |
$5,139.90 |
| Rate for Payer: Blue Shield of California EPN |
$3,049.67
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,142.20
|
| 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: United Healthcare All Other Commercial |
$2,156.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,106.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,060.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.63
|
|
|
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: Blue Shield of California EPN |
$1,061.59
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$397.60
|
| 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: United Healthcare All Other Commercial |
$750.67
|
| Rate for Payer: United Healthcare All Other HMO |
$733.17
|
| Rate for Payer: United Healthcare HMO Rider |
$717.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$656.04
|
|
|
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 |
$695.80 |
| Max. Negotiated Rate |
$1,789.20 |
| 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 |
$1,093.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$962.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.51
|
| Rate for Payer: Blue Distinction Transplant |
$1,192.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,491.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,081.47
|
| 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 Media |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,491.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$695.80
|
| 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: LLUH Dept of Risk Management WC |
$815.08
|
| 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 |
$994.00
|
| Rate for Payer: United Healthcare All Other HMO |
$994.00
|
| Rate for Payer: United Healthcare HMO Rider |
$994.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$994.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC KAFO SINGLE UPRIGHT PLSTIC W WO FM CUSTOM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT L2034
|
| Hospital Charge Code |
905352034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,754.19
|
| 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 Transplant |
$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 |
$2,191.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.58
|
| 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 |
$1,642.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,792.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,240.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,211.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,185.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,084.05
|
|
|
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 |
$1,149.75 |
| Max. Negotiated Rate |
$2,956.50 |
| 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 |
$1,806.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,590.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,940.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,971.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,463.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,787.04
|
| 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 Media |
$2,792.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,792.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,149.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,392.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.85
|
| 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 |
$1,642.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,642.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,642.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,642.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,792.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,792.25
|
|
