|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Multiplan Commercial |
$90.41
|
| Rate for Payer: Networks By Design Commercial |
$73.46
|
| 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
|
$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 |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California Commercial |
$28.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.85
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$35.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.85
|
| 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 |
$36.19
|
| 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
|
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 |
$35.39
|
| Rate for Payer: Blue Shield of California Commercial |
$44.96
|
| Rate for Payer: Blue Shield of California Commercial |
$29.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.50
|
| 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, 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.50
|
| 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 |
$38.01
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| 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 |
$33.53
|
| 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 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 |
$31.22
|
| Rate for Payer: Blue Shield of California Commercial |
$39.67
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| 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 |
$33.53
|
| 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 |
$31.22
|
| Rate for Payer: Blue Shield of California Commercial |
$39.67
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| 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
|
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 |
$45.51
|
| Rate for Payer: Blue Shield of California Commercial |
$57.82
|
| Rate for Payer: Blue Shield of California Commercial |
$38.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$47.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| 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 |
$48.87
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$49.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.25
|
| 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 |
$50.95
|
| 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 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 |
$47.45
|
| Rate for Payer: Blue Shield of California Commercial |
$60.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.74
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.25
|
| 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 XL DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502637
|
|
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 XL DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502637
|
|
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 XL DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502638
|
|
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 XL DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502638
|
|
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 XS DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502629
|
|
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 XS DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502629
|
|
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 XS DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502630
|
|
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 XS DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502630
|
|
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 XXL DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
OP
|
$6,748.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,735.80 |
| Rate for Payer: Adventist Health Commercial |
$2,766.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,711.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,061.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,084.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5,189.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,421.24
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cigna of CA HMO |
$4,723.60
|
| Rate for Payer: Cigna of CA PPO |
$4,723.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,735.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,735.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,699.20
|
| Rate for Payer: Galaxy Health WC |
$5,735.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,284.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,981.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,619.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,723.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,723.60
|
| Rate for Payer: Multiplan Commercial |
$5,398.40
|
| Rate for Payer: Networks By Design Commercial |
$3,374.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,735.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,048.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,048.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,532.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,209.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,735.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,735.80
|
|
|
HC BRACE XXL DF2 FEMUR FRACTURE LEFT STATIC KNEE
|
Facility
|
IP
|
$6,748.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,349.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,349.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cigna of CA HMO |
$4,723.60
|
| Rate for Payer: Cigna of CA PPO |
$4,723.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,699.20
|
| Rate for Payer: Galaxy Health WC |
$5,735.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,284.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,981.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,619.52
|
| Rate for Payer: Multiplan Commercial |
$5,398.40
|
| Rate for Payer: Networks By Design Commercial |
$4,386.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,735.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,532.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,209.97
|
|
|
HC BRACE XXL DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
IP
|
$6,748.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,349.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,349.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cigna of CA HMO |
$4,723.60
|
| Rate for Payer: Cigna of CA PPO |
$4,723.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,699.20
|
| Rate for Payer: Galaxy Health WC |
$5,735.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,284.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,981.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,619.52
|
| Rate for Payer: Multiplan Commercial |
$5,398.40
|
| Rate for Payer: Networks By Design Commercial |
$4,386.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,735.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,532.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,209.97
|
|
|
HC BRACE XXL DF2 FEMUR FRACTURE RIGHT STATIC KNEE
|
Facility
|
OP
|
$6,748.00
|
|
|
Service Code
|
CPT L2136
|
| Hospital Charge Code |
900502640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.16 |
| Max. Negotiated Rate |
$5,735.80 |
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cash Price |
$3,036.60
|
| Rate for Payer: Cigna of CA HMO |
$4,723.60
|
| Rate for Payer: Cigna of CA PPO |
$4,723.60
|
| Rate for Payer: Adventist Health Commercial |
$2,766.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,711.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,061.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,084.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5,189.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,421.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,735.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,735.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,699.20
|
| Rate for Payer: Galaxy Health WC |
$5,735.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,379.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,284.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,559.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,981.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,619.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,723.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,723.60
|
| Rate for Payer: Multiplan Commercial |
$5,398.40
|
| Rate for Payer: Networks By Design Commercial |
$3,374.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,735.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,048.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,048.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,532.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,209.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,735.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,735.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,735.80
|
|
