|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.48 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$324.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Cigna of CA HMO |
$1,038.08
|
| Rate for Payer: Cigna of CA PPO |
$1,200.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,135.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,378.70
|
| Rate for Payer: Global Benefits Group Commercial |
$973.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,378.70
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$1,378.70 |
| Rate for Payer: Adventist Health Commercial |
$324.40
|
| Rate for Payer: Cash Price |
$729.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,135.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.80
|
| Rate for Payer: EPIC Health Plan Senior |
$648.80
|
| Rate for Payer: Galaxy Health WC |
$1,378.70
|
| Rate for Payer: Global Benefits Group Commercial |
$973.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$956.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.28
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: Networks By Design Commercial |
$1,054.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,378.70
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
IP
|
$203.42
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cigna of CA HMO |
$142.39
|
| Rate for Payer: Cigna of CA PPO |
$142.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.37
|
| Rate for Payer: EPIC Health Plan Senior |
$81.37
|
| Rate for Payer: Galaxy Health WC |
$172.91
|
| Rate for Payer: Global Benefits Group Commercial |
$122.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.82
|
| Rate for Payer: Multiplan Commercial |
$162.74
|
| Rate for Payer: Networks By Design Commercial |
$132.22
|
| Rate for Payer: Prime Health Services Commercial |
$172.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Other HMO |
$74.31
|
| Rate for Payer: United Healthcare HMO Rider |
$72.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.62
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
OP
|
$203.42
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.13
|
| Rate for Payer: Blue Shield of California Commercial |
$156.43
|
| Rate for Payer: Blue Shield of California Commercial |
$103.13
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Cigna of CA HMO |
$142.39
|
| Rate for Payer: Cigna of CA PPO |
$142.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.37
|
| Rate for Payer: EPIC Health Plan Senior |
$81.37
|
| Rate for Payer: Galaxy Health WC |
$172.91
|
| Rate for Payer: Global Benefits Group Commercial |
$122.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.39
|
| Rate for Payer: Multiplan Commercial |
$162.74
|
| Rate for Payer: Networks By Design Commercial |
$101.71
|
| Rate for Payer: Prime Health Services Commercial |
$172.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Other HMO |
$74.31
|
| Rate for Payer: United Healthcare HMO Rider |
$72.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.91
|
| Rate for Payer: Vantage Medical Group Senior |
$172.91
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
IP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$143.86
|
| Rate for Payer: Networks By Design Commercial |
$116.89
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
OP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$152.86 |
| Rate for Payer: Adventist Health Commercial |
$73.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.85
|
| Rate for Payer: Blue Shield of California Commercial |
$91.17
|
| Rate for Payer: Blue Shield of California Commercial |
$138.29
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.88
|
| Rate for Payer: Multiplan Commercial |
$143.86
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.86
|
| Rate for Payer: Vantage Medical Group Senior |
$152.86
|
|
|
HC BRACE L DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE L DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE L DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE L DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$1,739.95 |
| Rate for Payer: Adventist Health Commercial |
$839.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,239.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.83
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.28
|
| Rate for Payer: Multiplan Commercial |
$1,637.60
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
|
|
HC BRACE M DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE M DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE M DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE M DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE S DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE S DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE S DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,249.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$4,061.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
|
|
HC BRACE S DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,310.80 |
| Rate for Payer: Adventist Health Commercial |
$2,561.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,436.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,686.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,781.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,804.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.74
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna of CA HMO |
$4,373.60
|
| Rate for Payer: Cigna of CA PPO |
$4,373.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,310.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,499.20
|
| Rate for Payer: Galaxy Health WC |
$5,310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,748.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,967.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,686.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,373.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,373.60
|
| Rate for Payer: Multiplan Commercial |
$4,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,124.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,282.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,310.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,310.80
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
OP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$265.43 |
| Rate for Payer: Adventist Health Commercial |
$128.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.02
|
| Rate for Payer: Blue Shield of California Commercial |
$240.14
|
| Rate for Payer: Blue Shield of California Commercial |
$158.32
|
| 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: Dignity Health Commercial/Exchange |
$265.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.59
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$187.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.36
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.43
|
| Rate for Payer: Vantage Medical Group Senior |
$265.43
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$62.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.24
|
| 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 |
$202.98
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$37.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.88
|
| 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 |
$38.43
|
| 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 |
$35.79
|
| Rate for Payer: Blue Shield of California Commercial |
$45.46
|
| Rate for Payer: Blue Shield of California Commercial |
$29.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.88
|
| 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
|
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 |
$68.40
|
| Rate for Payer: Blue Shield of California Commercial |
$57.30
|
| Rate for Payer: Blue Shield of California Commercial |
$86.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.68
|
| 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
|
|
