|
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 |
$52.59
|
| Rate for Payer: Cash Price |
$52.59
|
| 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 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 |
$52.59
|
| Rate for Payer: Cash Price |
$52.59
|
| 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 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 |
$58.98
|
| Rate for Payer: Cash Price |
$58.98
|
| 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 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 |
$58.98
|
| Rate for Payer: Cash Price |
$58.98
|
| 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 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 |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| 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 |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| 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 |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| 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 |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| 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
|
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 |
$150.61
|
| 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 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 |
$150.61
|
| Rate for Payer: Cash Price |
$150.61
|
| 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 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 |
$162.43
|
| Rate for Payer: Cash Price |
$162.43
|
| 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 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 |
$162.43
|
| 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 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 |
$150.61
|
| 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 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 |
$150.61
|
| Rate for Payer: Cash Price |
$150.61
|
| 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 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 |
$150.61
|
| Rate for Payer: Cash Price |
$150.61
|
| 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 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: Multiplan Commercial |
$219.07
|
| 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 |
$150.61
|
| 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: 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 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 |
$45.10
|
| 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
|
|
|
HC IMMOBILIZER SHLDR ELASTIC MED
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: 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: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
OP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.29
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: Cigna of CA HMO |
$53.45
|
| Rate for Payer: Cigna of CA PPO |
$61.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.76
|
| Rate for Payer: United Healthcare All Other HMO |
$41.76
|
| Rate for Payer: United Healthcare HMO Rider |
$41.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.99
|
| Rate for Payer: Vantage Medical Group Senior |
$70.99
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
IP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$45.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
OP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$82.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.52
|
| Rate for Payer: Blue Shield of California Commercial |
$148.47
|
| Rate for Payer: Blue Shield of California EPN |
$97.77
|
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.83
|
| Rate for Payer: Multiplan Commercial |
$160.94
|
| Rate for Payer: Networks By Design Commercial |
$100.59
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.00
|
| Rate for Payer: Vantage Medical Group Senior |
$171.00
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
IP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: Adventist Health Commercial |
$40.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.28
|
| Rate for Payer: Multiplan Commercial |
$160.94
|
| Rate for Payer: Networks By Design Commercial |
$100.59
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.50
|
| Rate for Payer: Blue Shield of California Commercial |
$32.49
|
| Rate for Payer: Blue Shield of California EPN |
$21.40
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
|
|
HC IMMOBILIZER SHLDR MED W/STRAPS
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Senior |
$23.68
|
| Rate for Payer: Galaxy Health WC |
$50.32
|
| Rate for Payer: Global Benefits Group Commercial |
$35.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.21
|
| Rate for Payer: Multiplan Commercial |
$47.36
|
| Rate for Payer: Networks By Design Commercial |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$50.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$21.63
|
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.39
|
|
