|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
IP
|
$38,400.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
915355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,680.00 |
| Max. Negotiated Rate |
$34,560.00 |
| Rate for Payer: Adventist Health Commercial |
$7,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29,683.20
|
| Rate for Payer: Blue Shield of California EPN |
$19,353.60
|
| Rate for Payer: Cash Price |
$21,120.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,720.00
|
| Rate for Payer: Cigna of CA HMO |
$26,880.00
|
| Rate for Payer: Cigna of CA PPO |
$26,880.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,360.00
|
| Rate for Payer: Galaxy Health WC |
$32,640.00
|
| Rate for Payer: Global Benefits Group Commercial |
$23,040.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,612.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,630.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,769.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,680.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$24,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,411.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14,027.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13,724.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,576.00
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
OP
|
$38,400.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
915355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,576.00 |
| Max. Negotiated Rate |
$34,560.00 |
| Rate for Payer: Adventist Health Commercial |
$15,744.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,120.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,800.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,552.32
|
| Rate for Payer: Blue Shield of California Commercial |
$29,683.20
|
| Rate for Payer: Blue Shield of California EPN |
$19,353.60
|
| Rate for Payer: Cash Price |
$21,120.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,720.00
|
| Rate for Payer: Cigna of CA HMO |
$26,880.00
|
| Rate for Payer: Cigna of CA PPO |
$26,880.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,640.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,360.00
|
| Rate for Payer: Galaxy Health WC |
$32,640.00
|
| Rate for Payer: Global Benefits Group Commercial |
$23,040.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,560.00
|
| Rate for Payer: InnovAge PACE Commercial |
$19,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,612.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,769.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,744.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,880.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,880.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$19,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,640.00
|
| Rate for Payer: Riverside University Health System MISP |
$15,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,040.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,040.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,411.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14,027.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13,724.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,576.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,640.00
|
| Rate for Payer: Vantage Medical Group Senior |
$32,640.00
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
IP
|
$40.67
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
OP
|
$40.67
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.89
|
| Rate for Payer: Blue Shield of California Commercial |
$24.85
|
| Rate for Payer: Blue Shield of California EPN |
$16.23
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$30.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: InnovAge PACE Commercial |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Riverside University Health System MISP |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
OP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Adventist Health Commercial |
$16.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.44
|
| Rate for Payer: Blue Shield of California Commercial |
$49.35
|
| Rate for Payer: Blue Shield of California EPN |
$32.23
|
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: Central Health Plan Commercial |
$64.62
|
| Rate for Payer: Cigna of CA HMO |
$51.69
|
| Rate for Payer: Cigna of CA PPO |
$59.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.69
|
| Rate for Payer: InnovAge PACE Commercial |
$40.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.54
|
| Rate for Payer: Multiplan Commercial |
$60.58
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
| Rate for Payer: Riverside University Health System MISP |
$32.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.38
|
| Rate for Payer: United Healthcare All Other HMO |
$40.38
|
| Rate for Payer: United Healthcare HMO Rider |
$40.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.65
|
| Rate for Payer: Vantage Medical Group Senior |
$68.65
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
IP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Adventist Health Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$44.42
|
| Rate for Payer: Central Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$60.58
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
|
|
HC KNEE STANDING
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$602.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.84
|
| Rate for Payer: Blue Shield of California Commercial |
$602.14
|
| Rate for Payer: Blue Shield of California EPN |
$393.82
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Central Health Plan Commercial |
$793.60
|
| Rate for Payer: Cigna of CA HMO |
$634.88
|
| Rate for Payer: Cigna of CA PPO |
$734.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$892.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$595.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC KNEE STANDING
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Central Health Plan Commercial |
$793.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$396.80
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
|
|
HC KNUCKLE BENDER
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC KNUCKLE BENDER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$169.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC KNUCKLE BENDER 2 SEGMENT/FLEX
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.67
|
| Rate for Payer: Blue Shield of California Commercial |
$324.66
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$294.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Riverside University Health System MISP |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC KNUCKLE BENDER 2 SEGMENT/FLEX
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.66
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.58 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.62
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: InnovAge PACE Commercial |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.58 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.62
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: InnovAge PACE Commercial |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
915351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Blue Shield of California Commercial |
$698.79
|
| Rate for Payer: Blue Shield of California EPN |
$455.62
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
915351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.06 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$370.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$530.92
|
| Rate for Payer: Blue Shield of California Commercial |
$698.79
|
| Rate for Payer: Blue Shield of California EPN |
$455.62
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$768.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$499.83
|
| Rate for Payer: InnovAge PACE Commercial |
$452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$632.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Riverside University Health System MISP |
$361.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.40
|
| Rate for Payer: Vantage Medical Group Senior |
$768.40
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Blue Shield of California Commercial |
$698.79
|
| Rate for Payer: Blue Shield of California EPN |
$455.62
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.06 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$370.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$530.92
|
| Rate for Payer: Blue Shield of California Commercial |
$698.79
|
| Rate for Payer: Blue Shield of California EPN |
$455.62
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$768.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$499.83
|
| Rate for Payer: InnovAge PACE Commercial |
$452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$632.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Riverside University Health System MISP |
$361.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.40
|
| Rate for Payer: Vantage Medical Group Senior |
$768.40
|
|
|
HC KO CTI TYPE
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$612.42 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$766.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,028.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,402.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,098.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.51
|
| Rate for Payer: Blue Shield of California EPN |
$942.48
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,309.00
|
| Rate for Payer: Cigna of CA PPO |
$1,309.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,589.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,108.44
|
| Rate for Payer: InnovAge PACE Commercial |
$935.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,309.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,309.00
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Networks By Design Commercial |
$935.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: Riverside University Health System MISP |
$748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.81
|
| Rate for Payer: United Healthcare All Other HMO |
$683.11
|
| Rate for Payer: United Healthcare HMO Rider |
$668.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,589.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,589.50
|
|
|
HC KO CTI TYPE
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.51
|
| Rate for Payer: Blue Shield of California EPN |
$942.48
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,309.00
|
| Rate for Payer: Cigna of CA PPO |
$1,309.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.81
|
| Rate for Payer: United Healthcare All Other HMO |
$683.11
|
| Rate for Payer: United Healthcare HMO Rider |
$668.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.42
|
|
|
HC KO DBL UPRIGHT ADJ FE\LEX/EXT
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
905361845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.60 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.61
|
| Rate for Payer: Blue Shield of California EPN |
$873.43
|
| Rate for Payer: Cash Price |
$953.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Cigna of CA HMO |
$1,213.10
|
| Rate for Payer: Cigna of CA PPO |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.39
|
| Rate for Payer: United Healthcare All Other HMO |
$633.06
|
| Rate for Payer: United Healthcare HMO Rider |
$619.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.56
|
|
|
HC KO DBL UPRIGHT ADJ FE\LEX/EXT
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
905361845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$567.56 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Adventist Health Commercial |
$710.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$953.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,299.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,017.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.61
|
| Rate for Payer: Blue Shield of California EPN |
$873.43
|
| Rate for Payer: Cash Price |
$953.15
|
| Rate for Payer: Cash Price |
$953.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Cigna of CA HMO |
$1,213.10
|
| Rate for Payer: Cigna of CA PPO |
$1,213.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,473.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,473.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.24
|
| Rate for Payer: InnovAge PACE Commercial |
$866.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,213.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,213.10
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Networks By Design Commercial |
$866.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: Riverside University Health System MISP |
$693.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,039.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.39
|
| Rate for Payer: United Healthcare All Other HMO |
$633.06
|
| Rate for Payer: United Healthcare HMO Rider |
$619.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,473.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,473.05
|
|
|
HC KO DBL UPRIGHT ADJ FLEX/EXT
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
915351845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.60 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.61
|
| Rate for Payer: Blue Shield of California EPN |
$873.43
|
| Rate for Payer: Cash Price |
$953.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Cigna of CA HMO |
$1,213.10
|
| Rate for Payer: Cigna of CA PPO |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.39
|
| Rate for Payer: United Healthcare All Other HMO |
$633.06
|
| Rate for Payer: United Healthcare HMO Rider |
$619.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.56
|
|
