|
HC KO RIGID MOLDED TO PT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
915351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$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 W/O JOINTS INC SFT IN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
915351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
905351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.40
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
915351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.40
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC KO RIGID W/O JOINTS INC SFT IN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1836
|
| Hospital Charge Code |
905351836
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$446.68 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$873.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.22
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.68
|
| Rate for Payer: InnovAge PACE Commercial |
$744.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Riverside University Health System MISP |
$595.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.22
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.22
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$446.68 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$873.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.22
|
| Rate for Payer: Blue Shield of California EPN |
$749.95
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.68
|
| Rate for Payer: InnovAge PACE Commercial |
$744.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Riverside University Health System MISP |
$595.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,719.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.36 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,719.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,687.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1,112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Riverside University Health System MISP |
$889.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.36 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,719.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,687.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1,112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Riverside University Health System MISP |
$889.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,719.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$402.73
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.20
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$402.73
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.20
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.63 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.98
|
| Rate for Payer: Blue Shield of California Commercial |
$402.73
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.00
|
| Rate for Payer: InnovAge PACE Commercial |
$260.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Riverside University Health System MISP |
$208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.63 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.98
|
| Rate for Payer: Blue Shield of California Commercial |
$402.73
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.00
|
| Rate for Payer: InnovAge PACE Commercial |
$260.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Riverside University Health System MISP |
$208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.58 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.06
|
| Rate for Payer: Blue Shield of California Commercial |
$629.22
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,057.07
|
| Rate for Payer: InnovAge PACE Commercial |
$407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Riverside University Health System MISP |
$325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.58 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.06
|
| Rate for Payer: Blue Shield of California Commercial |
$629.22
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,057.07
|
| Rate for Payer: InnovAge PACE Commercial |
$407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Riverside University Health System MISP |
$325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Blue Shield of California Commercial |
$629.22
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Blue Shield of California Commercial |
$629.22
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.70 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,840.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,687.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,863.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,972.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,077.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,687.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,687.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.70 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,840.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,687.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,863.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,972.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,077.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
