|
HC KO DBL UPRIGHT ADJ FLEX/EXT
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
915351845
|
|
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 |
905351845
|
|
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 FLEX/EXT
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
905351845
|
|
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 CUSTOM
|
Facility
|
IP
|
$2,402.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351846
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$480.40 |
| Max. Negotiated Rate |
$2,161.80 |
| Rate for Payer: Adventist Health Commercial |
$480.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,856.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,210.61
|
| Rate for Payer: Cash Price |
$1,321.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,921.60
|
| Rate for Payer: Cigna of CA HMO |
$1,681.40
|
| Rate for Payer: Cigna of CA PPO |
$1,681.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.80
|
| Rate for Payer: EPIC Health Plan Senior |
$960.80
|
| Rate for Payer: Galaxy Health WC |
$2,041.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,441.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,161.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,602.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$915.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.40
|
| Rate for Payer: Multiplan Commercial |
$1,801.50
|
| Rate for Payer: Networks By Design Commercial |
$1,561.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,041.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$901.47
|
| Rate for Payer: United Healthcare All Other HMO |
$877.45
|
| Rate for Payer: United Healthcare HMO Rider |
$858.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.65
|
|
|
HC KO DBL UPRIGHT CUSTOM
|
Facility
|
OP
|
$2,402.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351846
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$786.65 |
| Max. Negotiated Rate |
$2,161.80 |
| Rate for Payer: Adventist Health Commercial |
$984.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,041.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,321.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,801.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,856.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,210.61
|
| Rate for Payer: Cash Price |
$1,321.10
|
| Rate for Payer: Cash Price |
$1,321.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,921.60
|
| Rate for Payer: Cigna of CA HMO |
$1,681.40
|
| Rate for Payer: Cigna of CA PPO |
$1,681.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,041.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,041.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,041.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.80
|
| Rate for Payer: EPIC Health Plan Senior |
$960.80
|
| Rate for Payer: Galaxy Health WC |
$2,041.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,441.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,161.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,108.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,602.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,681.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,681.40
|
| Rate for Payer: Multiplan Commercial |
$1,801.50
|
| Rate for Payer: Networks By Design Commercial |
$1,201.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,041.70
|
| Rate for Payer: Riverside University Health System MISP |
$960.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,441.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,441.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$901.47
|
| Rate for Payer: United Healthcare All Other HMO |
$877.45
|
| Rate for Payer: United Healthcare HMO Rider |
$858.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,041.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,041.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,041.70
|
|
|
HC KO DBL UPRIGHT MOLDED
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.76 |
| Max. Negotiated Rate |
$1,224.44 |
| Rate for Payer: Adventist Health Commercial |
$555.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,151.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$745.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,016.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,047.41
|
| Rate for Payer: Blue Shield of California EPN |
$682.92
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: Cigna of CA HMO |
$948.50
|
| Rate for Payer: Cigna of CA PPO |
$948.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,151.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,151.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,151.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$542.00
|
| Rate for Payer: Galaxy Health WC |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,108.44
|
| Rate for Payer: InnovAge PACE Commercial |
$677.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$838.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$948.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$948.50
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$677.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
| Rate for Payer: Riverside University Health System MISP |
$542.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$813.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.53
|
| Rate for Payer: United Healthcare All Other HMO |
$494.98
|
| Rate for Payer: United Healthcare HMO Rider |
$484.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,151.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,151.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,151.75
|
|
|
HC KO DBL UPRIGHT MOLDED
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,047.41
|
| Rate for Payer: Blue Shield of California EPN |
$682.92
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: Cigna of CA HMO |
$948.50
|
| Rate for Payer: Cigna of CA PPO |
$948.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$542.00
|
| Rate for Payer: Galaxy Health WC |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$838.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.53
|
| Rate for Payer: United Healthcare All Other HMO |
$494.98
|
| Rate for Payer: United Healthcare HMO Rider |
$484.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.76
|
|
|
HC KO, DEROTATION MOLDED TO PT
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT L1840
|
| Hospital Charge Code |
905351840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$604.57 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Adventist Health Commercial |
$756.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,015.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,384.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,426.96
|
| Rate for Payer: Blue Shield of California EPN |
$930.38
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: Cigna of CA HMO |
$1,292.20
|
| Rate for Payer: Cigna of CA PPO |
$1,292.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,569.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,127.84
|
| Rate for Payer: InnovAge PACE Commercial |
$923.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,245.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,142.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,292.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,292.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: Riverside University Health System MISP |
$738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,107.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$692.80
|
| Rate for Payer: United Healthcare All Other HMO |
$674.34
|
| Rate for Payer: United Healthcare HMO Rider |
$659.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$604.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,569.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,569.10
|
|
|
HC KO, DEROTATION MOLDED TO PT
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT L1840
|
| Hospital Charge Code |
905351840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Adventist Health Commercial |
$369.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,426.96
|
| Rate for Payer: Blue Shield of California EPN |
$930.38
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: Cigna of CA HMO |
$1,292.20
|
| Rate for Payer: Cigna of CA PPO |
$1,292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,142.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$692.80
|
| Rate for Payer: United Healthcare All Other HMO |
$674.34
|
| Rate for Payer: United Healthcare HMO Rider |
$659.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$604.57
|
|
|
HC KO, DEROTATION MOLDED TO PT
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT L1840
|
| Hospital Charge Code |
915351840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$604.57 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Adventist Health Commercial |
$756.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,015.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,384.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,426.96
|
| Rate for Payer: Blue Shield of California EPN |
$930.38
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: Cigna of CA HMO |
$1,292.20
|
| Rate for Payer: Cigna of CA PPO |
$1,292.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,569.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,127.84
|
| Rate for Payer: InnovAge PACE Commercial |
$923.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,245.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,142.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,292.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,292.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: Riverside University Health System MISP |
$738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,107.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$692.80
|
| Rate for Payer: United Healthcare All Other HMO |
$674.34
|
| Rate for Payer: United Healthcare HMO Rider |
$659.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$604.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,569.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,569.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,569.10
|
|
|
HC KO, DEROTATION MOLDED TO PT
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT L1840
|
| Hospital Charge Code |
915351840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Adventist Health Commercial |
$369.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,426.96
|
| Rate for Payer: Blue Shield of California EPN |
$930.38
|
| Rate for Payer: Cash Price |
$1,015.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: Cigna of CA HMO |
$1,292.20
|
| Rate for Payer: Cigna of CA PPO |
$1,292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,142.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$692.80
|
| Rate for Payer: United Healthcare All Other HMO |
$674.34
|
| Rate for Payer: United Healthcare HMO Rider |
$659.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$604.57
|
|
|
HC KO ELASTIC KNEE CAP
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
905351825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC KO ELASTIC KNEE CAP
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
905351825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC KO ELASTIC W/CONDYLAR PAD/JTS
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
905351820
|
|
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 |
$254.65
|
| 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 ELASTIC W/CONDYLAR PAD/JTS
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
905351820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.79 |
| 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 |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| 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 |
$138.79
|
| 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 |
$153.31
|
| 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 ELASTIC W/CONDYLAR PAD/JTS
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
915351820
|
|
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 |
$254.65
|
| 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 ELASTIC W/CONDYLAR PAD/JTS
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
915351820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.79 |
| 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 |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| 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 |
$138.79
|
| 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 |
$153.31
|
| 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 ELASTIC WITH CONDYLAR PADS
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
905351815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$59.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.57
|
| Rate for Payer: Blue Shield of California Commercial |
$111.31
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: InnovAge PACE Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$72.00
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Riverside University Health System MISP |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC KO ELASTIC WITH CONDYLAR PADS
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
905351815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$111.31
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
|
|
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 |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| 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
|
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 |
$225.50
|
| 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 |
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 |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| 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
|
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 |
$225.50
|
| 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 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 |
$106.15
|
| 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 |
$106.15
|
| 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
|
|
