|
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 |
$254.70 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Blue Shield of California Commercial |
$226.97
|
| Rate for Payer: Blue Shield of California EPN |
$142.63
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Central Health Plan Commercial |
$226.40
|
| 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: Health Management Network EPO/PPO |
$254.70
|
| 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 |
$56.60
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
| 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 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 |
$416.70 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Blue Shield of California Commercial |
$371.33
|
| Rate for Payer: Blue Shield of California EPN |
$233.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| 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: Health Management Network EPO/PPO |
$416.70
|
| 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 |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
| 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 |
915351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.63 |
| Max. Negotiated Rate |
$416.70 |
| 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 |
$269.33
|
| Rate for Payer: Blue Shield of California Commercial |
$371.33
|
| Rate for Payer: Blue Shield of California EPN |
$233.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| 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: Health Management Network EPO/PPO |
$416.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.22
|
| 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 |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
| Rate for Payer: Networks By Design Commercial |
$231.50
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
| Rate for Payer: Riverside University Health System MISP |
$185.20
|
| 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 |
905351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.63 |
| Max. Negotiated Rate |
$416.70 |
| 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 |
$269.33
|
| Rate for Payer: Blue Shield of California Commercial |
$371.33
|
| Rate for Payer: Blue Shield of California EPN |
$233.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| 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: Health Management Network EPO/PPO |
$416.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.22
|
| 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 |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
| Rate for Payer: Networks By Design Commercial |
$231.50
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
| Rate for Payer: Riverside University Health System MISP |
$185.20
|
| 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 |
$416.70 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Blue Shield of California Commercial |
$371.33
|
| Rate for Payer: Blue Shield of California EPN |
$233.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| 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: Health Management Network EPO/PPO |
$416.70
|
| 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 |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
| 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
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.42 |
| Max. Negotiated Rate |
$1,221.30 |
| 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 |
$789.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.31
|
| Rate for Payer: Blue Shield of California EPN |
$683.93
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| 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: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.05
|
| 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 |
$556.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Riverside University Health System MISP |
$542.80
|
| 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
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
915351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.31
|
| Rate for Payer: Blue Shield of California EPN |
$683.93
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| 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: Health Management Network EPO/PPO |
$1,221.30
|
| 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 |
$271.40
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| 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 |
915351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.42 |
| Max. Negotiated Rate |
$1,221.30 |
| 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 |
$789.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.31
|
| Rate for Payer: Blue Shield of California EPN |
$683.93
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| 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: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.05
|
| 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 |
$556.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Riverside University Health System MISP |
$542.80
|
| 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
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.31
|
| Rate for Payer: Blue Shield of California EPN |
$683.93
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| 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: Health Management Network EPO/PPO |
$1,221.30
|
| 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 |
$271.40
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| 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 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 |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$696.94
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| 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: Health Management Network EPO/PPO |
$782.10
|
| 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 |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| 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 |
$284.60 |
| Max. Negotiated Rate |
$782.10 |
| 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 |
$505.50
|
| Rate for Payer: Blue Shield of California Commercial |
$696.94
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| 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: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$688.69
|
| 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 |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health System MISP |
$347.60
|
| 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
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
915351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$782.10 |
| 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 |
$505.50
|
| Rate for Payer: Blue Shield of California Commercial |
$696.94
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| 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: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$688.69
|
| 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 |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health System MISP |
$347.60
|
| 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 |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$696.94
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| 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: Health Management Network EPO/PPO |
$782.10
|
| 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 |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| 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 |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| 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 |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.40
|
| 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 |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| 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 |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| 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 |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.40
|
| 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 |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| 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 |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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: Health Management Network EPO/PPO |
$189.00
|
| 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 |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| 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 |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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: Health Management Network EPO/PPO |
$189.00
|
| 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 |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| 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 |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$446.68 |
| Max. Negotiated Rate |
$1,339.20 |
| 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 |
$865.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.38
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| 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: 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: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.68
|
| 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 |
$610.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Riverside University Health System MISP |
$595.20
|
| 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 |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.38
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| 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: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| 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
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.38
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| 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: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| 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 |
$446.68 |
| Max. Negotiated Rate |
$1,339.20 |
| 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 |
$865.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.38
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| 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: 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: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.68
|
| 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 |
$610.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Riverside University Health System MISP |
$595.20
|
| 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 |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| 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 |
$728.36 |
| Max. Negotiated Rate |
$2,001.60 |
| 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 |
$1,293.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,687.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Riverside University Health System MISP |
$889.60
|
| 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
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| 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 |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.36 |
| Max. Negotiated Rate |
$2,001.60 |
| 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 |
$1,293.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,687.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Riverside University Health System MISP |
$889.60
|
| 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
|
|
