|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Adventist Health Commercial |
$108.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.74
|
| Rate for Payer: Blue Shield of California Commercial |
$195.89
|
| Rate for Payer: Blue Shield of California EPN |
$129.00
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
IP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.08
|
| Rate for Payer: Multiplan Commercial |
$80.26
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
OP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Adventist Health Commercial |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.11
|
| Rate for Payer: Blue Shield of California Commercial |
$74.04
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.22
|
| Rate for Payer: Multiplan Commercial |
$80.26
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.27
|
| Rate for Payer: Vantage Medical Group Senior |
$85.27
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.53
|
| Rate for Payer: Multiplan Commercial |
$118.44
|
| Rate for Payer: Networks By Design Commercial |
$74.03
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.75
|
| Rate for Payer: Blue Shield of California Commercial |
$109.26
|
| Rate for Payer: Blue Shield of California EPN |
$71.95
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$118.44
|
| Rate for Payer: Networks By Design Commercial |
$74.03
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.84
|
| Rate for Payer: Vantage Medical Group Senior |
$125.84
|
|
|
HC SUPPORT ELBOW MEDIUM
|
Facility
|
IP
|
$42.15
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607792
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cigna of CA HMO |
$29.50
|
| Rate for Payer: Cigna of CA PPO |
$29.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.86
|
| Rate for Payer: EPIC Health Plan Senior |
$16.86
|
| Rate for Payer: Galaxy Health WC |
$35.83
|
| Rate for Payer: Global Benefits Group Commercial |
$25.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$33.72
|
| Rate for Payer: Networks By Design Commercial |
$21.07
|
| Rate for Payer: Prime Health Services Commercial |
$35.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.40
|
| Rate for Payer: United Healthcare HMO Rider |
$15.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
|
|
HC SUPPORT ELBOW MEDIUM
|
Facility
|
OP
|
$42.15
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607792
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.41
|
| Rate for Payer: Blue Shield of California Commercial |
$31.11
|
| Rate for Payer: Blue Shield of California EPN |
$20.48
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cigna of CA HMO |
$29.50
|
| Rate for Payer: Cigna of CA PPO |
$29.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.86
|
| Rate for Payer: EPIC Health Plan Senior |
$16.86
|
| Rate for Payer: Galaxy Health WC |
$35.83
|
| Rate for Payer: Global Benefits Group Commercial |
$25.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$33.72
|
| Rate for Payer: Networks By Design Commercial |
$21.07
|
| Rate for Payer: Prime Health Services Commercial |
$35.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.40
|
| Rate for Payer: United Healthcare HMO Rider |
$15.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.83
|
| Rate for Payer: Vantage Medical Group Senior |
$35.83
|
|
|
HC SUPPORT ELBOW XLARGE
|
Facility
|
IP
|
$36.90
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607794
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cigna of CA HMO |
$25.83
|
| Rate for Payer: Cigna of CA PPO |
$25.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$18.45
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.85
|
| Rate for Payer: United Healthcare All Other HMO |
$13.48
|
| Rate for Payer: United Healthcare HMO Rider |
$13.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.08
|
|
|
HC SUPPORT ELBOW XLARGE
|
Facility
|
OP
|
$36.90
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607794
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.37
|
| Rate for Payer: Blue Shield of California Commercial |
$27.23
|
| Rate for Payer: Blue Shield of California EPN |
$17.93
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cigna of CA HMO |
$25.83
|
| Rate for Payer: Cigna of CA PPO |
$25.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$18.45
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.85
|
| Rate for Payer: United Healthcare All Other HMO |
$13.48
|
| Rate for Payer: United Healthcare HMO Rider |
$13.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.36
|
| Rate for Payer: Vantage Medical Group Senior |
$31.36
|
|
|
HC SUPPORTER ATHLETIC LRG 38-44"
|
Facility
|
OP
|
$34.60
|
|
| Hospital Charge Code |
901698455
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Adventist Health Commercial |
$6.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.25
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$25.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$29.41
|
| Rate for Payer: Global Benefits Group Commercial |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.22
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$22.49
|
| Rate for Payer: Prime Health Services Commercial |
$29.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17.30
|
| Rate for Payer: United Healthcare HMO Rider |
$17.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.41
|
| Rate for Payer: Vantage Medical Group Senior |
$29.41
|
|
|
HC SUPPORTER ATHLETIC LRG 38-44"
|
Facility
|
IP
|
$34.60
|
|
| Hospital Charge Code |
901698455
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Adventist Health Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$29.41
|
| Rate for Payer: Global Benefits Group Commercial |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$22.49
|
| Rate for Payer: Prime Health Services Commercial |
$29.41
|
|
|
HC SUPPORTER ATHLETIC MED 32-38"
|
Facility
|
IP
|
$34.60
|
|
| Hospital Charge Code |
901698454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Adventist Health Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$29.41
|
| Rate for Payer: Global Benefits Group Commercial |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$22.49
|
| Rate for Payer: Prime Health Services Commercial |
$29.41
|
|
|
HC SUPPORTER ATHLETIC MED 32-38"
|
Facility
|
OP
|
$34.60
|
|
| Hospital Charge Code |
901698454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Adventist Health Commercial |
$6.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.25
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cigna of CA HMO |
$22.14
|
| Rate for Payer: Cigna of CA PPO |
$25.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$29.41
|
| Rate for Payer: Global Benefits Group Commercial |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.22
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$22.49
|
| Rate for Payer: Prime Health Services Commercial |
$29.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17.30
|
| Rate for Payer: United Healthcare HMO Rider |
$17.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.41
|
| Rate for Payer: Vantage Medical Group Senior |
$29.41
|
|
|
HC SUPPORT KNEE HINGED LARGE
|
Facility
|
OP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606731
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$88.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.53
|
| Rate for Payer: Blue Shield of California EPN |
$105.05
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.31
|
| Rate for Payer: Multiplan Commercial |
$172.93
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.74
|
| Rate for Payer: Vantage Medical Group Senior |
$183.74
|
|
|
HC SUPPORT KNEE HINGED LARGE
|
Facility
|
IP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606731
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.88
|
| Rate for Payer: Multiplan Commercial |
$172.93
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
|
|
HC SUPPORT KNEE HINGED MED.
|
Facility
|
IP
|
$228.62
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$45.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cigna of CA HMO |
$160.03
|
| Rate for Payer: Cigna of CA PPO |
$160.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.45
|
| Rate for Payer: EPIC Health Plan Senior |
$91.45
|
| Rate for Payer: Galaxy Health WC |
$194.33
|
| Rate for Payer: Global Benefits Group Commercial |
$137.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.87
|
| Rate for Payer: Multiplan Commercial |
$182.90
|
| Rate for Payer: Networks By Design Commercial |
$114.31
|
| Rate for Payer: Prime Health Services Commercial |
$194.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.80
|
| Rate for Payer: United Healthcare All Other HMO |
$83.51
|
| Rate for Payer: United Healthcare HMO Rider |
$81.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.87
|
|
|
HC SUPPORT KNEE HINGED MED.
|
Facility
|
OP
|
$228.62
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.87 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$93.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.42
|
| Rate for Payer: Blue Shield of California Commercial |
$168.72
|
| Rate for Payer: Blue Shield of California EPN |
$111.11
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cigna of CA HMO |
$160.03
|
| Rate for Payer: Cigna of CA PPO |
$160.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.45
|
| Rate for Payer: EPIC Health Plan Senior |
$91.45
|
| Rate for Payer: Galaxy Health WC |
$194.33
|
| Rate for Payer: Global Benefits Group Commercial |
$137.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.03
|
| Rate for Payer: Multiplan Commercial |
$182.90
|
| Rate for Payer: Networks By Design Commercial |
$114.31
|
| Rate for Payer: Prime Health Services Commercial |
$194.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.80
|
| Rate for Payer: United Healthcare All Other HMO |
$83.51
|
| Rate for Payer: United Healthcare HMO Rider |
$81.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.33
|
| Rate for Payer: Vantage Medical Group Senior |
$194.33
|
|
|
HC SUPPORT KNEE HINGED X-LARGE
|
Facility
|
IP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606732
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.88
|
| Rate for Payer: Multiplan Commercial |
$172.93
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
|
|
HC SUPPORT KNEE HINGED X-LARGE
|
Facility
|
OP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606732
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$88.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.53
|
| Rate for Payer: Blue Shield of California EPN |
$105.05
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.31
|
| Rate for Payer: Multiplan Commercial |
$172.93
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.74
|
| Rate for Payer: Vantage Medical Group Senior |
$183.74
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
OP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$972.99 |
| Rate for Payer: Adventist Health Commercial |
$73.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.79
|
| Rate for Payer: Blue Shield of California Commercial |
$132.25
|
| Rate for Payer: Blue Shield of California EPN |
$87.09
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$860.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.44
|
| Rate for Payer: Multiplan Commercial |
$143.36
|
| Rate for Payer: Networks By Design Commercial |
$89.60
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Vantage Medical Group Senior |
$152.32
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
IP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cash Price |
$98.56
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.01
|
| Rate for Payer: Multiplan Commercial |
$143.36
|
| Rate for Payer: Networks By Design Commercial |
$89.60
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
IP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
OP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.38
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$19.16
|
| Rate for Payer: Cigna of CA PPO |
$22.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.96
|
| Rate for Payer: United Healthcare All Other HMO |
$14.96
|
| Rate for Payer: United Healthcare HMO Rider |
$14.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: Vantage Medical Group Senior |
$25.44
|
|
|
HC SUPPORT SACRO LUMBAR XLG
|
Facility
|
IP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.36
|
| Rate for Payer: EPIC Health Plan Senior |
$57.36
|
| Rate for Payer: Galaxy Health WC |
$121.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.42
|
| Rate for Payer: Multiplan Commercial |
$114.73
|
| Rate for Payer: Networks By Design Commercial |
$71.70
|
| Rate for Payer: Prime Health Services Commercial |
$121.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.82
|
| Rate for Payer: United Healthcare All Other HMO |
$52.39
|
| Rate for Payer: United Healthcare HMO Rider |
$51.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.97
|
|
