|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
IP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.94
|
| Rate for Payer: Multiplan Commercial |
$249.82
|
| Rate for Payer: Networks By Design Commercial |
$156.13
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
|
|
HC BRACE, THUMB CURAD UNIVERSAL
|
Facility
|
IP
|
$59.12
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO |
$41.38
|
| Rate for Payer: Cigna of CA PPO |
$41.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.65
|
| Rate for Payer: EPIC Health Plan Senior |
$23.65
|
| Rate for Payer: Galaxy Health WC |
$50.25
|
| Rate for Payer: Global Benefits Group Commercial |
$35.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$47.30
|
| Rate for Payer: Networks By Design Commercial |
$29.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.19
|
| Rate for Payer: United Healthcare All Other HMO |
$21.60
|
| Rate for Payer: United Healthcare HMO Rider |
$21.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.36
|
|
|
HC BRACE, THUMB CURAD UNIVERSAL
|
Facility
|
OP
|
$59.12
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Adventist Health Commercial |
$24.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.24
|
| Rate for Payer: Blue Shield of California Commercial |
$43.63
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO |
$41.38
|
| Rate for Payer: Cigna of CA PPO |
$41.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.65
|
| Rate for Payer: EPIC Health Plan Senior |
$23.65
|
| Rate for Payer: Galaxy Health WC |
$50.25
|
| Rate for Payer: Global Benefits Group Commercial |
$35.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.38
|
| Rate for Payer: Multiplan Commercial |
$47.30
|
| Rate for Payer: Networks By Design Commercial |
$29.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.19
|
| Rate for Payer: United Healthcare All Other HMO |
$21.60
|
| Rate for Payer: United Healthcare HMO Rider |
$21.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.25
|
| Rate for Payer: Vantage Medical Group Senior |
$50.25
|
|
|
HC BRACE THUMB UNIVERSAL
|
Facility
|
IP
|
$113.01
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
901607804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.11
|
| Rate for Payer: Cigna of CA PPO |
$79.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.06
|
| Rate for Payer: Global Benefits Group Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.41
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BRACE THUMB UNIVERSAL
|
Facility
|
OP
|
$113.01
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
901607804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$96.06 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$83.40
|
| Rate for Payer: Blue Shield of California EPN |
$54.92
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.11
|
| Rate for Payer: Cigna of CA PPO |
$79.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.06
|
| Rate for Payer: Global Benefits Group Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.11
|
| Rate for Payer: Multiplan Commercial |
$90.41
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.06
|
| Rate for Payer: Vantage Medical Group Senior |
$96.06
|
|
|
HC BRACE, THUMB UNIVERSAL
|
Facility
|
OP
|
$55.68
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698531
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$47.33 |
| Rate for Payer: Adventist Health Commercial |
$22.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.25
|
| Rate for Payer: Blue Shield of California Commercial |
$41.09
|
| Rate for Payer: Blue Shield of California EPN |
$27.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cigna of CA HMO |
$38.98
|
| Rate for Payer: Cigna of CA PPO |
$38.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.27
|
| Rate for Payer: Galaxy Health WC |
$47.33
|
| Rate for Payer: Global Benefits Group Commercial |
$33.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.98
|
| Rate for Payer: Multiplan Commercial |
$44.54
|
| Rate for Payer: Networks By Design Commercial |
$27.84
|
| Rate for Payer: Prime Health Services Commercial |
$47.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.33
|
| Rate for Payer: Vantage Medical Group Senior |
$47.33
|
|
|
HC BRACE, THUMB UNIVERSAL
|
Facility
|
IP
|
$55.68
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698531
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cigna of CA HMO |
$38.98
|
| Rate for Payer: Cigna of CA PPO |
$38.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.27
|
| Rate for Payer: Galaxy Health WC |
$47.33
|
| Rate for Payer: Global Benefits Group Commercial |
$33.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.36
|
| Rate for Payer: Multiplan Commercial |
$44.54
|
| Rate for Payer: Networks By Design Commercial |
$27.84
|
| Rate for Payer: Prime Health Services Commercial |
$47.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.24
|
|
|
HC BRACE, THUMB UNIV W/ADJ STRAPS
|
Facility
|
IP
|
$58.47
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$40.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Senior |
$23.39
|
| Rate for Payer: Galaxy Health WC |
$49.70
|
| Rate for Payer: Global Benefits Group Commercial |
$35.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.03
|
| Rate for Payer: Multiplan Commercial |
$46.78
|
| Rate for Payer: Networks By Design Commercial |
$29.23
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
|
|
HC BRACE, THUMB UNIV W/ADJ STRAPS
|
Facility
|
OP
|
$58.47
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$49.70 |
| Rate for Payer: Adventist Health Commercial |
$23.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.87
|
| Rate for Payer: Blue Shield of California Commercial |
$43.15
|
| Rate for Payer: Blue Shield of California EPN |
$28.42
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$40.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Senior |
$23.39
|
| Rate for Payer: Galaxy Health WC |
$49.70
|
| Rate for Payer: Global Benefits Group Commercial |
$35.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.93
|
| Rate for Payer: Multiplan Commercial |
$46.78
|
| Rate for Payer: Networks By Design Commercial |
$29.23
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.70
|
| Rate for Payer: Vantage Medical Group Senior |
$49.70
|
|
|
HC BRACE WRIST LFT SUPPORT WRAP
|
Facility
|
OP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.07
|
| Rate for Payer: Blue Shield of California EPN |
$25.07
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.11
|
| Rate for Payer: Multiplan Commercial |
$41.26
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$43.84
|
|
|
HC BRACE WRIST LFT SUPPORT WRAP
|
Facility
|
IP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$41.26
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
|
|
HC BRACE WRIST RT SUPPORT WRAP
|
Facility
|
IP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698592
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$41.26
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
|
|
HC BRACE WRIST RT SUPPORT WRAP
|
Facility
|
OP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698592
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.07
|
| Rate for Payer: Blue Shield of California EPN |
$25.07
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.11
|
| Rate for Payer: Multiplan Commercial |
$41.26
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$43.84
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
|
IP
|
$75.19
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$15.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$52.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: EPIC Health Plan Senior |
$30.08
|
| Rate for Payer: Galaxy Health WC |
$63.91
|
| Rate for Payer: Global Benefits Group Commercial |
$45.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$37.59
|
| Rate for Payer: Prime Health Services Commercial |
$63.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.22
|
| Rate for Payer: United Healthcare All Other HMO |
$27.47
|
| Rate for Payer: United Healthcare HMO Rider |
$26.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.62
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
|
OP
|
$75.19
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.55
|
| Rate for Payer: Blue Shield of California Commercial |
$55.49
|
| Rate for Payer: Blue Shield of California EPN |
$36.54
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: EPIC Health Plan Senior |
$30.08
|
| Rate for Payer: Galaxy Health WC |
$63.91
|
| Rate for Payer: Global Benefits Group Commercial |
$45.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.63
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$37.59
|
| Rate for Payer: Prime Health Services Commercial |
$63.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.22
|
| Rate for Payer: United Healthcare All Other HMO |
$27.47
|
| Rate for Payer: United Healthcare HMO Rider |
$26.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.91
|
| Rate for Payer: Vantage Medical Group Senior |
$63.91
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
|
OP
|
$78.39
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.40
|
| Rate for Payer: Blue Shield of California Commercial |
$57.85
|
| Rate for Payer: Blue Shield of California EPN |
$38.10
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$54.87
|
| Rate for Payer: Cigna of CA PPO |
$54.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Senior |
$31.36
|
| Rate for Payer: Galaxy Health WC |
$66.63
|
| Rate for Payer: Global Benefits Group Commercial |
$47.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.87
|
| Rate for Payer: Multiplan Commercial |
$62.71
|
| Rate for Payer: Networks By Design Commercial |
$39.20
|
| Rate for Payer: Prime Health Services Commercial |
$66.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.64
|
| Rate for Payer: United Healthcare HMO Rider |
$28.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.63
|
| Rate for Payer: Vantage Medical Group Senior |
$66.63
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
|
IP
|
$78.39
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$15.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$54.87
|
| Rate for Payer: Cigna of CA PPO |
$54.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Senior |
$31.36
|
| Rate for Payer: Galaxy Health WC |
$66.63
|
| Rate for Payer: Global Benefits Group Commercial |
$47.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.81
|
| Rate for Payer: Multiplan Commercial |
$62.71
|
| Rate for Payer: Networks By Design Commercial |
$39.20
|
| Rate for Payer: Prime Health Services Commercial |
$66.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.64
|
| Rate for Payer: United Healthcare HMO Rider |
$28.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.67
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$465.13 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,272.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,980.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2,120.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cigna of CA HMO |
$2,217.60
|
| Rate for Payer: Cigna of CA PPO |
$2,564.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,079.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,386.00
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,144.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,386.00
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,144.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
OP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$465.13 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,272.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,980.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2,120.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cigna of CA HMO |
$2,217.60
|
| Rate for Payer: Cigna of CA PPO |
$2,564.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,079.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,267.20
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,207.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,960.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.28 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,077.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,458.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,938.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,279.87
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna of CA HMO |
$2,027.52
|
| Rate for Payer: Cigna of CA PPO |
$2,344.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$365.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,900.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$2,775.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.35 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$555.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,820.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,118.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,698.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,121.10
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cigna of CA HMO |
$1,776.00
|
| Rate for Payer: Cigna of CA PPO |
$2,053.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,358.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,850.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,803.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,358.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,665.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$2,775.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$555.00
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,110.00
|
| Rate for Payer: Galaxy Health WC |
$2,358.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,850.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,057.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,717.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,803.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,358.75
|
|
