|
HC KO LOCKING JOINT POS
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
905351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$393.55 |
| Rate for Payer: Adventist Health Commercial |
$189.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$347.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.17
|
| Rate for Payer: Blue Shield of California Commercial |
$341.69
|
| Rate for Payer: Blue Shield of California EPN |
$225.02
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$393.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$393.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$393.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$393.55
|
| Rate for Payer: Global Benefits Group Commercial |
$277.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: Networks By Design Commercial |
$231.50
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Other HMO |
$169.13
|
| Rate for Payer: United Healthcare HMO Rider |
$165.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$393.55
|
| Rate for Payer: Vantage Medical Group Senior |
$393.55
|
|
|
HC KO LOCKING JOINT POS
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
915351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$393.55 |
| Rate for Payer: Adventist Health Commercial |
$189.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$347.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.17
|
| Rate for Payer: Blue Shield of California Commercial |
$341.69
|
| Rate for Payer: Blue Shield of California EPN |
$225.02
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$393.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$393.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$393.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$393.55
|
| Rate for Payer: Global Benefits Group Commercial |
$277.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: Networks By Design Commercial |
$231.50
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Other HMO |
$169.13
|
| Rate for Payer: United Healthcare HMO Rider |
$165.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$393.55
|
| Rate for Payer: Vantage Medical Group Senior |
$393.55
|
|
|
HC KO LOCKING JOINT POS
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
915351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$393.55
|
| Rate for Payer: Global Benefits Group Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.12
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: Networks By Design Commercial |
$231.50
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Other HMO |
$169.13
|
| Rate for Payer: United Healthcare HMO Rider |
$165.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.63
|
|
|
HC KO NON-MOLDED LACER
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351880
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cigna of CA HMO |
$735.70
|
| Rate for Payer: Cigna of CA PPO |
$735.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$525.50
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.44
|
| Rate for Payer: United Healthcare All Other HMO |
$383.93
|
| Rate for Payer: United Healthcare HMO Rider |
$375.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.20
|
|
|
HC KO NON-MOLDED LACER
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351880
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.24 |
| Max. Negotiated Rate |
$1,224.44 |
| Rate for Payer: Adventist Health Commercial |
$430.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$788.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.74
|
| Rate for Payer: Blue Shield of California Commercial |
$775.64
|
| Rate for Payer: Blue Shield of California EPN |
$510.79
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cigna of CA HMO |
$735.70
|
| Rate for Payer: Cigna of CA PPO |
$735.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$893.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$893.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,082.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.70
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$525.50
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.44
|
| Rate for Payer: United Healthcare All Other HMO |
$383.93
|
| Rate for Payer: United Healthcare HMO Rider |
$375.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$893.35
|
| Rate for Payer: Vantage Medical Group Senior |
$893.35
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
915351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$556.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.47
|
| Rate for Payer: Blue Shield of California EPN |
$659.50
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$870.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
915351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$556.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.47
|
| Rate for Payer: Blue Shield of California EPN |
$659.50
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$870.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
915351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$760.76 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.32
|
| Rate for Payer: Blue Shield of California Commercial |
$641.32
|
| Rate for Payer: Blue Shield of California EPN |
$422.33
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$672.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
915351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
905351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$760.76 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.32
|
| Rate for Payer: Blue Shield of California Commercial |
$641.32
|
| Rate for Payer: Blue Shield of California EPN |
$422.33
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$672.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
905351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
915351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
905351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
915351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
905351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$861.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.14
|
| Rate for Payer: Blue Shield of California EPN |
$723.17
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$861.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.14
|
| Rate for Payer: Blue Shield of California EPN |
$723.17
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,080.86
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,080.86
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cash Price |
$1,223.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
