|
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: Blue Shield of California EPN |
$925.42
|
| Rate for Payer: Cash Price |
$779.85
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$346.60
|
| 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
|
|
|
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 |
$606.55 |
| Max. Negotiated Rate |
$3,393.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,393.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,473.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$953.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$953.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$839.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,023.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1,039.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.75
|
| Rate for Payer: Blue Shield of California EPN |
$942.75
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| 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: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,299.75
|
| Rate for Payer: IEHP medi-cal |
$606.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.53
|
| 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 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 |
$866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$866.50
|
| Rate for Payer: United Healthcare HMO Rider |
$866.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.50
|
| 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: Blue Shield of California EPN |
$1,282.67
|
| Rate for Payer: Cash Price |
$1,080.90
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$480.40
|
| 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
|
|
|
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 |
$840.70 |
| Max. Negotiated Rate |
$4,637.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,637.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,041.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,321.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,321.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,163.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.10
|
| Rate for Payer: BCBS Transplant Transplant |
$1,441.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,801.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,306.69
|
| Rate for Payer: Cash Price |
$1,080.90
|
| Rate for Payer: Cash Price |
$1,080.90
|
| 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: EPIC Health Plan Commercial |
$960.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,801.50
|
| Rate for Payer: IEHP medi-cal |
$840.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,602.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.82
|
| 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 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 |
$1,201.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,201.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,201.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,201.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,041.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,041.70
|
|
|
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 |
$646.10 |
| Max. Negotiated Rate |
$3,817.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,817.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,569.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,015.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,015.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$893.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.62
|
| Rate for Payer: BCBS Transplant Transplant |
$1,107.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,004.22
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Cash Price |
$830.70
|
| 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: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,384.50
|
| Rate for Payer: IEHP medi-cal |
$646.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.86
|
| 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 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 |
$923.00
|
| Rate for Payer: United Healthcare All Other HMO |
$923.00
|
| Rate for Payer: United Healthcare HMO Rider |
$923.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$923.00
|
| 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: Blue Shield of California EPN |
$985.76
|
| Rate for Payer: Cash Price |
$830.70
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$369.20
|
| 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
|
|
|
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: Blue Shield of California EPN |
$247.24
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$92.60
|
| 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
|
|
|
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 |
$162.05 |
| Max. Negotiated Rate |
$538.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$538.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$254.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$254.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$224.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.54
|
| Rate for Payer: BCBS Transplant Transplant |
$277.80
|
| Rate for Payer: Blue Shield of California Commercial |
$347.25
|
| Rate for Payer: Blue Shield of California EPN |
$251.87
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$393.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$347.25
|
| Rate for Payer: IEHP medi-cal |
$162.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.83
|
| 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 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 |
$231.50
|
| Rate for Payer: United Healthcare All Other HMO |
$231.50
|
| Rate for Payer: United Healthcare HMO Rider |
$231.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$393.55
|
| Rate for Payer: Vantage Medical Group Senior |
$393.55
|
|
|
HC KO ELASTIC WITH JOINTS
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
905351810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$408.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$408.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$225.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.23
|
| Rate for Payer: BCBS Transplant Transplant |
$246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.50
|
| Rate for Payer: Blue Shield of California EPN |
$223.04
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$307.50
|
| Rate for Payer: IEHP medi-cal |
$143.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| 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 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 |
$205.00
|
| Rate for Payer: United Healthcare All Other HMO |
$205.00
|
| Rate for Payer: United Healthcare HMO Rider |
$205.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$205.00
|
| 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: Blue Shield of California EPN |
$218.94
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$82.00
|
| 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
|
|
|
HC KO LOCKING JOINT POS
|
Facility
OP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
905351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$1,167.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,167.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$393.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$254.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$254.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$224.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.54
|
| Rate for Payer: BCBS Transplant Transplant |
$277.80
|
| Rate for Payer: Blue Shield of California Commercial |
$347.25
|
| Rate for Payer: Blue Shield of California EPN |
$251.87
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$393.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$347.25
|
| Rate for Payer: IEHP medi-cal |
$162.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.83
|
| 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 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 |
$231.50
|
| Rate for Payer: United Healthcare All Other HMO |
$231.50
|
| Rate for Payer: United Healthcare HMO Rider |
$231.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$393.55
|
| Rate for Payer: Vantage Medical Group Senior |
$393.55
|
|
|
HC KO LOCKING JOINT POS
|
Facility
IP
|
$463.00
|
|
|
Service Code
|
CPT L1831
|
| Hospital Charge Code |
905351831
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$416.70 |
| Rate for Payer: Blue Shield of California EPN |
$247.24
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| Rate for Payer: Cigna of CA HMO |
$324.10
|
| Rate for Payer: Cigna of CA PPO |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$92.60
|
| 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
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
IP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Blue Shield of California EPN |
$724.64
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.40
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
|
|
HC KO PROSTHETIC SOCKET CUSTOM
|
Facility
OP
|
$1,357.00
|
|
|
Service Code
|
CPT L1860
|
| Hospital Charge Code |
905351860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.95 |
| Max. Negotiated Rate |
$4,454.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,454.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$746.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$657.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$801.72
|
| Rate for Payer: BCBS Transplant Transplant |
$814.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.75
|
| Rate for Payer: Blue Shield of California EPN |
$738.21
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,017.75
|
| Rate for Payer: IEHP medi-cal |
$474.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.37
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Riverside University Health MISP |
$542.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.50
|
| Rate for Payer: United Healthcare All Other HMO |
$678.50
|
| Rate for Payer: United Healthcare HMO Rider |
$678.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
IP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
905351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Blue Shield of California EPN |
$464.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
HC KO RIGID MOLDED TO PT
|
Facility
OP
|
$869.00
|
|
|
Service Code
|
CPT L1834
|
| Hospital Charge Code |
905351834
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.15 |
| Max. Negotiated Rate |
$3,222.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,222.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$477.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.41
|
| Rate for Payer: BCBS Transplant Transplant |
$521.40
|
| Rate for Payer: Blue Shield of California Commercial |
$651.75
|
| Rate for Payer: Blue Shield of California EPN |
$472.74
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$651.75
|
| Rate for Payer: IEHP medi-cal |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health MISP |
$347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.50
|
| Rate for Payer: United Healthcare All Other HMO |
$434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
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: Blue Shield of California EPN |
$112.14
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$42.00
|
| 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
|
|
|
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 |
$73.50 |
| Max. Negotiated Rate |
$529.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$529.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: BCBS Transplant Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California EPN |
$114.24
|
| 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: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$157.50
|
| Rate for Payer: IEHP medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| 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 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 |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
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: Blue Shield of California EPN |
$794.59
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$297.60
|
| 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
|
|
|
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 |
$520.80 |
| Max. Negotiated Rate |
$3,558.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,558.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$818.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$720.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$879.11
|
| Rate for Payer: BCBS Transplant Transplant |
$892.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.00
|
| Rate for Payer: Blue Shield of California EPN |
$809.47
|
| 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: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,116.00
|
| Rate for Payer: IEHP medi-cal |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.08
|
| 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 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 |
$744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$744.00
|
| 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
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$778.40 |
| Max. Negotiated Rate |
$6,601.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,601.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,223.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,076.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,313.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1,334.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.86
|
| 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: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,668.00
|
| Rate for Payer: IEHP medi-cal |
$778.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.84
|
| 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 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 |
$1,112.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,112.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,112.00
|
| 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: Blue Shield of California EPN |
$1,187.62
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$444.80
|
| 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
|
|
|
HC KO SWEDISH TYPE
|
Facility
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.35 |
| Max. Negotiated Rate |
$1,194.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,194.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$286.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.81
|
| Rate for Payer: BCBS Transplant Transplant |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$390.75
|
| Rate for Payer: Blue Shield of California EPN |
$283.42
|
| 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: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$390.75
|
| Rate for Payer: IEHP medi-cal |
$182.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| 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 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 |
$260.50
|
| Rate for Payer: United Healthcare All Other HMO |
$260.50
|
| Rate for Payer: United Healthcare HMO Rider |
$260.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
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: Blue Shield of California EPN |
$278.21
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$104.20
|
| 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
|
|
|
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 |
$3,480.75 |
| Max. Negotiated Rate |
$15,365.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,365.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,469.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,815.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,875.51
|
| Rate for Payer: BCBS Transplant Transplant |
$5,967.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,458.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,410.08
|
| 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: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7,458.75
|
| Rate for Payer: IEHP medi-cal |
$3,480.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,077.45
|
| 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 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 |
$4,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,972.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
