|
HC KO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
915351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.17
|
| Rate for Payer: Blue Shield of California Commercial |
$315.29
|
| Rate for Payer: Blue Shield of California Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC KO ELASTIC WITH STAYS
|
Facility
|
IP
|
$193.00
|
|
| Hospital Charge Code |
905351800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC KO ELASTIC WITH STAYS
|
Facility
|
OP
|
$193.00
|
|
| Hospital Charge Code |
905351800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.82
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
905351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cigna of CA HMO |
$198.10
|
| Rate for Payer: Cigna of CA PPO |
$198.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: EPIC Health Plan Senior |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.92
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Networks By Design Commercial |
$183.95
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
905351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: Adventist Health Commercial |
$116.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.30
|
| Rate for Payer: Blue Shield of California Commercial |
$217.63
|
| Rate for Payer: Blue Shield of California Commercial |
$143.48
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cigna of CA HMO |
$198.10
|
| Rate for Payer: Cigna of CA PPO |
$198.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: EPIC Health Plan Senior |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.10
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Networks By Design Commercial |
$141.50
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.55
|
| Rate for Payer: Vantage Medical Group Senior |
$240.55
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
915351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cigna of CA HMO |
$198.10
|
| Rate for Payer: Cigna of CA PPO |
$198.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: EPIC Health Plan Senior |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.92
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Networks By Design Commercial |
$183.95
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
915351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: Adventist Health Commercial |
$116.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.30
|
| Rate for Payer: Blue Shield of California Commercial |
$217.63
|
| Rate for Payer: Blue Shield of California Commercial |
$143.48
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Cigna of CA HMO |
$198.10
|
| Rate for Payer: Cigna of CA PPO |
$198.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: EPIC Health Plan Senior |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.10
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Networks By Design Commercial |
$141.50
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.55
|
| Rate for Payer: Vantage Medical Group Senior |
$240.55
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.17
|
| 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 |
$300.95
|
| 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 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 |
$280.25
|
| Rate for Payer: Blue Shield of California Commercial |
$356.05
|
| Rate for Payer: Blue Shield of California Commercial |
$234.74
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.17
|
| 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: Vantage Medical Group Senior |
$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 |
$280.25
|
| Rate for Payer: Blue Shield of California Commercial |
$356.05
|
| Rate for Payer: Blue Shield of California Commercial |
$234.74
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.17
|
| 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
|
|
|
HC KO LOCKING JOINT POS
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
905351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.17
|
| 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 |
$300.95
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.63
|
| 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 |
$882.05
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.63
|
| 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 |
$882.05
|
| 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 |
$821.39
|
| Rate for Payer: Blue Shield of California Commercial |
$688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.53
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$870.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.63
|
| 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 |
$821.39
|
| Rate for Payer: Blue Shield of California Commercial |
$688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.53
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$870.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.63
|
| 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
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
905351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| 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 |
$564.85
|
| 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: Vantage Medical Group Senior |
$738.65
|
| 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 |
$526.01
|
| Rate for Payer: Blue Shield of California Commercial |
$668.26
|
| Rate for Payer: Blue Shield of California Commercial |
$440.58
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$672.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| 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
|
|
|
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 |
$526.01
|
| Rate for Payer: Blue Shield of California Commercial |
$668.26
|
| Rate for Payer: Blue Shield of California Commercial |
$440.58
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$672.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| 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 |
$564.85
|
| 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
|
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 |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
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 |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
915351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
$136.50
|
| 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
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
905351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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 |
$136.50
|
| 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
|
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 |
$900.69
|
| Rate for Payer: Blue Shield of California Commercial |
$754.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.27
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| 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
|
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 |
$900.69
|
| Rate for Payer: Blue Shield of California Commercial |
$754.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.27
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| 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
|
|
