|
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 |
$60.72
|
| Rate for Payer: Blue Shield of California Commercial |
$77.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.86
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Cash Price |
$45.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.19
|
| 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
|
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: 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 |
$89.61
|
| Rate for Payer: Blue Shield of California Commercial |
$75.06
|
| Rate for Payer: Blue Shield of California Commercial |
$113.85
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cash Price |
$66.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.35
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Networks By Design Commercial |
$96.23
|
| Rate for Payer: Adventist Health Commercial |
$29.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$94.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.53
|
| Rate for Payer: Multiplan Commercial |
$118.44
|
| 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 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 |
$25.51
|
| Rate for Payer: Blue Shield of California Commercial |
$32.41
|
| Rate for Payer: Blue Shield of California Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.87
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cigna of CA HMO |
$29.50
|
| Rate for Payer: Cigna of CA PPO |
$29.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$26.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.87
|
| 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 |
$27.40
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$25.83
|
| Rate for Payer: Cigna of CA PPO |
$25.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| 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 |
$23.98
|
| 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 |
$22.34
|
| Rate for Payer: Blue Shield of California Commercial |
$28.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.71
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$16.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| 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 LARGE
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SUPPORTER ATHLETIC LARGE
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC 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 |
$22.20
|
| Rate for Payer: Cash Price |
$15.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.22
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.41
|
| 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 |
$15.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.22
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.41
|
| 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 |
$15.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.22
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.41
|
| 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 |
$22.20
|
| Rate for Payer: Cash Price |
$15.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.22
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.41
|
| 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 |
$130.84
|
| Rate for Payer: Blue Shield of California Commercial |
$166.23
|
| Rate for Payer: Blue Shield of California Commercial |
$109.59
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| 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 |
$140.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Cigna of CA HMO |
$160.03
|
| Rate for Payer: Cigna of CA PPO |
$160.03
|
| Rate for Payer: Adventist Health Commercial |
$45.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$145.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.89
|
| 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 |
$148.60
|
| 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 |
$138.38
|
| Rate for Payer: Blue Shield of California Commercial |
$175.81
|
| Rate for Payer: Blue Shield of California Commercial |
$115.91
|
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Cash Price |
$102.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.89
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| 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 |
$140.50
|
| 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 |
$130.84
|
| Rate for Payer: Blue Shield of California Commercial |
$166.23
|
| Rate for Payer: Blue Shield of California Commercial |
$109.59
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| 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 |
$108.47
|
| Rate for Payer: Blue Shield of California Commercial |
$90.85
|
| Rate for Payer: Blue Shield of California Commercial |
$137.80
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cash Price |
$80.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$860.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$972.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.73
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$113.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.73
|
| 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 |
$116.48
|
| 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
|
OP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.46
|
| 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 |
$19.21
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cash Price |
$13.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| 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 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 |
$13.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| 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 SACRO LUMBAR XLG
|
Facility
|
OP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Vantage Medical Group Senior |
$121.90
|
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.81
|
| Rate for Payer: Blue Shield of California Commercial |
$72.71
|
| Rate for Payer: Blue Shield of California Commercial |
$110.28
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.39
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$86.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.05
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.90
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$91.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.61
|
| 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 |
$93.22
|
| 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
|
|
