|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$3,527.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$705.40 |
| Max. Negotiated Rate |
$2,997.95 |
| Rate for Payer: Adventist Health Commercial |
$705.40
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.80
|
| Rate for Payer: Galaxy Health WC |
$2,997.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,116.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,352.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,343.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,183.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.48
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: Networks By Design Commercial |
$2,292.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,997.95
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$3,527.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$705.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cigna of CA HMO |
$2,257.28
|
| Rate for Payer: Cigna of CA PPO |
$2,609.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$2,997.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,116.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,352.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,292.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,997.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$265.46 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.46
|
| Rate for Payer: Blue Shield of California Commercial |
$18.73
|
| Rate for Payer: Blue Shield of California EPN |
$12.38
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.25
|
| Rate for Payer: EPIC Health Plan Senior |
$35.74
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.89
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.95
|
| Rate for Payer: United Healthcare All Other HMO |
$28.95
|
| Rate for Payer: United Healthcare HMO Rider |
$28.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
IP
|
$155.26
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$108.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.10
|
| Rate for Payer: EPIC Health Plan Senior |
$62.10
|
| Rate for Payer: Galaxy Health WC |
$131.97
|
| Rate for Payer: Global Benefits Group Commercial |
$93.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.26
|
| Rate for Payer: Multiplan Commercial |
$124.21
|
| Rate for Payer: Networks By Design Commercial |
$77.63
|
| Rate for Payer: Prime Health Services Commercial |
$131.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.27
|
| Rate for Payer: United Healthcare All Other HMO |
$56.72
|
| Rate for Payer: United Healthcare HMO Rider |
$55.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.85
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
OP
|
$155.26
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.26 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$63.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.93
|
| Rate for Payer: Blue Shield of California Commercial |
$114.58
|
| Rate for Payer: Blue Shield of California EPN |
$75.46
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$108.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.10
|
| Rate for Payer: EPIC Health Plan Senior |
$62.10
|
| Rate for Payer: Galaxy Health WC |
$131.97
|
| Rate for Payer: Global Benefits Group Commercial |
$93.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.68
|
| Rate for Payer: Multiplan Commercial |
$124.21
|
| Rate for Payer: Networks By Design Commercial |
$77.63
|
| Rate for Payer: Prime Health Services Commercial |
$131.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.27
|
| Rate for Payer: United Healthcare All Other HMO |
$56.72
|
| Rate for Payer: United Healthcare HMO Rider |
$55.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.97
|
| Rate for Payer: Vantage Medical Group Senior |
$131.97
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
OP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.38
|
| Rate for Payer: Blue Shield of California Commercial |
$70.56
|
| Rate for Payer: Blue Shield of California EPN |
$46.47
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Senior |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.93
|
| Rate for Payer: Multiplan Commercial |
$76.49
|
| Rate for Payer: Networks By Design Commercial |
$47.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Other HMO |
$34.93
|
| Rate for Payer: United Healthcare HMO Rider |
$34.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.27
|
| Rate for Payer: Vantage Medical Group Senior |
$81.27
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
IP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Senior |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.95
|
| Rate for Payer: Multiplan Commercial |
$76.49
|
| Rate for Payer: Networks By Design Commercial |
$47.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Other HMO |
$34.93
|
| Rate for Payer: United Healthcare HMO Rider |
$34.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.31
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
OP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.11
|
| Rate for Payer: Blue Shield of California Commercial |
$79.14
|
| Rate for Payer: Blue Shield of California EPN |
$52.12
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Senior |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.07
|
| Rate for Payer: Multiplan Commercial |
$85.79
|
| Rate for Payer: Networks By Design Commercial |
$53.62
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.25
|
| Rate for Payer: United Healthcare All Other HMO |
$39.17
|
| Rate for Payer: United Healthcare HMO Rider |
$38.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.15
|
| Rate for Payer: Vantage Medical Group Senior |
$91.15
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
IP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Senior |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$85.79
|
| Rate for Payer: Networks By Design Commercial |
$53.62
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.25
|
| Rate for Payer: United Healthcare All Other HMO |
$39.17
|
| Rate for Payer: United Healthcare HMO Rider |
$38.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.04
|
| Rate for Payer: Blue Shield of California Commercial |
$112.18
|
| Rate for Payer: Blue Shield of California EPN |
$73.87
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.04
|
| Rate for Payer: Blue Shield of California Commercial |
$112.18
|
| Rate for Payer: Blue Shield of California EPN |
$73.87
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
IP
|
$273.84
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
OP
|
$273.84
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Adventist Health Commercial |
$112.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.61
|
| Rate for Payer: Blue Shield of California Commercial |
$202.09
|
| Rate for Payer: Blue Shield of California EPN |
$133.09
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.69
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.76
|
| Rate for Payer: Vantage Medical Group Senior |
$232.76
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
OP
|
$295.33
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$251.03 |
| Rate for Payer: Adventist Health Commercial |
$121.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$221.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.06
|
| Rate for Payer: Blue Shield of California Commercial |
$217.95
|
| Rate for Payer: Blue Shield of California EPN |
$143.53
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna of CA HMO |
$206.73
|
| Rate for Payer: Cigna of CA PPO |
$206.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.13
|
| Rate for Payer: EPIC Health Plan Senior |
$118.13
|
| Rate for Payer: Galaxy Health WC |
$251.03
|
| Rate for Payer: Global Benefits Group Commercial |
$177.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.73
|
| Rate for Payer: Multiplan Commercial |
$236.26
|
| Rate for Payer: Networks By Design Commercial |
$147.66
|
| Rate for Payer: Prime Health Services Commercial |
$251.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.84
|
| Rate for Payer: United Healthcare All Other HMO |
$107.88
|
| Rate for Payer: United Healthcare HMO Rider |
$105.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.03
|
| Rate for Payer: Vantage Medical Group Senior |
$251.03
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
IP
|
$295.33
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.07 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna of CA HMO |
$206.73
|
| Rate for Payer: Cigna of CA PPO |
$206.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.13
|
| Rate for Payer: EPIC Health Plan Senior |
$118.13
|
| Rate for Payer: Galaxy Health WC |
$251.03
|
| Rate for Payer: Global Benefits Group Commercial |
$177.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.88
|
| Rate for Payer: Multiplan Commercial |
$236.26
|
| Rate for Payer: Networks By Design Commercial |
$147.66
|
| Rate for Payer: Prime Health Services Commercial |
$251.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.84
|
| Rate for Payer: United Healthcare All Other HMO |
$107.88
|
| Rate for Payer: United Healthcare HMO Rider |
$105.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.72
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
IP
|
$273.84
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
OP
|
$273.84
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Adventist Health Commercial |
$112.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.61
|
| Rate for Payer: Blue Shield of California Commercial |
$202.09
|
| Rate for Payer: Blue Shield of California EPN |
$133.09
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.69
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.76
|
| Rate for Payer: Vantage Medical Group Senior |
$232.76
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
OP
|
$273.84
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Adventist Health Commercial |
$112.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.61
|
| Rate for Payer: Blue Shield of California Commercial |
$202.09
|
| Rate for Payer: Blue Shield of California EPN |
$133.09
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.69
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.76
|
| Rate for Payer: Vantage Medical Group Senior |
$232.76
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
IP
|
$273.84
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
|
|
HC IMMOBILIZER SHLDR ELASTIC MED
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
