|
HC KO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
905351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC KO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
915351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC KO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
905351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.79
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.03
|
| Rate for Payer: InnovAge PACE Commercial |
$205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health System MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC KO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
915351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.79
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.03
|
| Rate for Payer: InnovAge PACE Commercial |
$205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health System MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC KO ELASTIC WITH STAYS
|
Facility
|
IP
|
$193.00
|
|
| Hospital Charge Code |
905351800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC KO ELASTIC WITH STAYS
|
Facility
|
OP
|
$193.00
|
|
| Hospital Charge Code |
905351800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.35
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: InnovAge PACE Commercial |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
905351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Blue Shield of California Commercial |
$218.76
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.18
|
| 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 IMMOBILIZER, CANVAS LONG
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
915351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Blue Shield of California Commercial |
$218.76
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.18
|
| 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 IMMOBILIZER, CANVAS LONG
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
905351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Adventist Health Commercial |
$116.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.21
|
| Rate for Payer: Blue Shield of California Commercial |
$218.76
|
| Rate for Payer: Blue Shield of California EPN |
$142.63
|
| Rate for Payer: Cash Price |
$127.35
|
| 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: Dignity Health Commercial/Exchange |
$240.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.55
|
| Rate for Payer: 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: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$141.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.10
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
| Rate for Payer: Networks By Design Commercial |
$141.50
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: Riverside University Health System MISP |
$113.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.55
|
| Rate for Payer: Vantage Medical Group Senior |
$240.55
|
|
|
HC KO IMMOBILIZER, CANVAS LONG
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
915351830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Adventist Health Commercial |
$116.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.21
|
| Rate for Payer: Blue Shield of California Commercial |
$218.76
|
| Rate for Payer: Blue Shield of California EPN |
$142.63
|
| Rate for Payer: Cash Price |
$127.35
|
| 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: Dignity Health Commercial/Exchange |
$240.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.55
|
| Rate for Payer: 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: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$141.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.10
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
| Rate for Payer: Networks By Design Commercial |
$141.50
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
| Rate for Payer: Riverside University Health System MISP |
$113.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.21
|
| Rate for Payer: United Healthcare All Other HMO |
$103.38
|
| Rate for Payer: United Healthcare HMO Rider |
$101.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.55
|
| Rate for Payer: Vantage Medical Group Senior |
$240.55
|
|
|
HC KO LACER MOLDED TO PT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351870
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.29 |
| Max. Negotiated Rate |
$1,224.44 |
| Rate for Payer: Adventist Health Commercial |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.93
|
| Rate for Payer: Blue Shield of California Commercial |
$977.85
|
| Rate for Payer: Blue Shield of California EPN |
$637.56
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$885.50
|
| Rate for Payer: Cigna of CA PPO |
$885.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,108.44
|
| Rate for Payer: InnovAge PACE Commercial |
$632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$632.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Riverside University Health System MISP |
$506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.75
|
| Rate for Payer: United Healthcare All Other HMO |
$462.10
|
| Rate for Payer: United Healthcare HMO Rider |
$452.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC KO LACER MOLDED TO PT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351870
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Blue Shield of California Commercial |
$977.85
|
| Rate for Payer: Blue Shield of California EPN |
$637.56
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$885.50
|
| Rate for Payer: Cigna of CA PPO |
$885.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.75
|
| Rate for Payer: United Healthcare All Other HMO |
$462.10
|
| Rate for Payer: United Healthcare HMO Rider |
$452.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.29
|
|
|
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 |
$271.92
|
| Rate for Payer: Blue Shield of California Commercial |
$357.90
|
| 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: 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: InnovAge PACE Commercial |
$231.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$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 |
$357.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$271.92
|
| Rate for Payer: Blue Shield of California Commercial |
$357.90
|
| 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: 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: InnovAge PACE Commercial |
$231.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.10
|
| Rate for Payer: Multiplan Commercial |
$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 |
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 |
$357.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 NON-MOLDED LACER
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351880
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$945.90 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Blue Shield of California Commercial |
$812.42
|
| Rate for Payer: Blue Shield of California EPN |
$529.70
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Central Health Plan Commercial |
$840.80
|
| Rate for Payer: Cigna of CA HMO |
$735.70
|
| Rate for Payer: Cigna of CA PPO |
$735.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.20
|
| Rate for Payer: Multiplan Commercial |
$788.25
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.44
|
| Rate for Payer: United Healthcare All Other HMO |
$383.93
|
| Rate for Payer: United Healthcare HMO Rider |
$375.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.20
|
|
|
HC KO NON-MOLDED LACER
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351880
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.20 |
| Max. Negotiated Rate |
$1,224.44 |
| Rate for Payer: Adventist Health Commercial |
$430.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$788.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.25
|
| Rate for Payer: Blue Shield of California Commercial |
$812.42
|
| Rate for Payer: Blue Shield of California EPN |
$529.70
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Central Health Plan Commercial |
$840.80
|
| Rate for Payer: Cigna of CA HMO |
$735.70
|
| Rate for Payer: Cigna of CA PPO |
$735.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$893.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$893.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,108.44
|
| Rate for Payer: InnovAge PACE Commercial |
$525.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.70
|
| Rate for Payer: Multiplan Commercial |
$788.25
|
| Rate for Payer: Networks By Design Commercial |
$525.50
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: Riverside University Health System MISP |
$420.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.44
|
| Rate for Payer: United Healthcare All Other HMO |
$383.93
|
| Rate for Payer: United Healthcare HMO Rider |
$375.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$893.35
|
| Rate for Payer: Vantage Medical Group Senior |
$893.35
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
915351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.96
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$796.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.96
|
| 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: 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: InnovAge PACE Commercial |
$678.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| 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 |
$1,048.96
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$796.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.96
|
| 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: 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: InnovAge PACE Commercial |
$678.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| 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 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 |
$510.36
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| 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: 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: InnovAge PACE Commercial |
$434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$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 |
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 |
$671.74
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$510.36
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| 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: 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: InnovAge PACE Commercial |
$434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
