|
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: Cigna of CA PPO |
$206.73
|
| 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 |
$178.76
|
| Rate for Payer: Blue Shield of California Commercial |
$149.73
|
| Rate for Payer: Blue Shield of California Commercial |
$227.11
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna of CA HMO |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$187.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.24
|
| 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
|
IP
|
$273.84
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| 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 |
$178.00
|
| 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 |
$165.76
|
| Rate for Payer: Blue Shield of California Commercial |
$138.84
|
| Rate for Payer: Blue Shield of California Commercial |
$210.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| 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 |
$178.00
|
| 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: 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 |
$165.76
|
| Rate for Payer: Blue Shield of California Commercial |
$138.84
|
| Rate for Payer: Blue Shield of California Commercial |
$210.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| 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 SHLDR ELASTIC MED
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.95
|
| 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 |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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: 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 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 |
$152.46 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.46
|
| 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 |
$53.59
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cash Price |
$37.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$53.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.28
|
| 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 |
$37.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$53.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.28
|
| 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 |
$121.77
|
| Rate for Payer: Blue Shield of California Commercial |
$154.71
|
| Rate for Payer: Blue Shield of California Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cash Price |
$90.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.83
|
| 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 Foundation Hospitals Commercial/Self Funded |
$127.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.70
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.83
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.70
|
| 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 |
$130.77
|
| 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
|
IP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| 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 |
$28.62
|
| 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 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 |
$26.65
|
| Rate for Payer: Blue Shield of California Commercial |
$33.86
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| 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 MED W/STRAPS
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: Adventist Health Commercial |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.83
|
| Rate for Payer: Blue Shield of California Commercial |
$45.52
|
| Rate for Payer: Blue Shield of California Commercial |
$30.01
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.44
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$35.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.52
|
| 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 Select/Navigate/Core |
$19.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.32
|
| Rate for Payer: Vantage Medical Group Senior |
$50.32
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$37.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.93
|
| 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 |
$38.48
|
| 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
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
OP
|
$70.93
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Adventist Health Commercial |
$29.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.93
|
| Rate for Payer: Blue Shield of California Commercial |
$54.55
|
| Rate for Payer: Blue Shield of California Commercial |
$35.96
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$49.65
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$35.47
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.62
|
| Rate for Payer: United Healthcare All Other HMO |
$25.91
|
| Rate for Payer: United Healthcare HMO Rider |
$25.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
IP
|
$70.93
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$49.65
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.62
|
| Rate for Payer: United Healthcare All Other HMO |
$25.91
|
| Rate for Payer: United Healthcare HMO Rider |
$25.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.23
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.03
|
| Rate for Payer: United Healthcare HMO Rider |
$20.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.85
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Vantage Medical Group Senior |
$48.93
|
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.84
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$29.18
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.03
|
| Rate for Payer: United Healthcare HMO Rider |
$20.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.93
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
908710588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.07
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
908710588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
908710589
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.07
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54.40
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
908710589
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
