|
HC SUPPORT ELBOW MEDIUM
|
Facility
|
OP
|
$42.15
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607792
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.52
|
| Rate for Payer: Blue Shield of California Commercial |
$33.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.24
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Central Health Plan Commercial |
$33.72
|
| Rate for Payer: Cigna of CA HMO |
$29.50
|
| Rate for Payer: Cigna of CA PPO |
$29.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.86
|
| Rate for Payer: EPIC Health Plan Senior |
$16.86
|
| Rate for Payer: Galaxy Health WC |
$35.83
|
| Rate for Payer: Global Benefits Group Commercial |
$25.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$31.61
|
| Rate for Payer: Networks By Design Commercial |
$21.07
|
| Rate for Payer: Prime Health Services Commercial |
$35.83
|
| Rate for Payer: Riverside University Health System MISP |
$16.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.40
|
| Rate for Payer: United Healthcare HMO Rider |
$15.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.83
|
| Rate for Payer: Vantage Medical Group Senior |
$35.83
|
|
|
HC SUPPORT ELBOW MEDIUM
|
Facility
|
IP
|
$42.15
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607792
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$33.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.24
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Central Health Plan Commercial |
$33.72
|
| Rate for Payer: Cigna of CA HMO |
$29.50
|
| Rate for Payer: Cigna of CA PPO |
$29.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.86
|
| Rate for Payer: EPIC Health Plan Senior |
$16.86
|
| Rate for Payer: Galaxy Health WC |
$35.83
|
| Rate for Payer: Global Benefits Group Commercial |
$25.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.43
|
| Rate for Payer: Multiplan Commercial |
$31.61
|
| Rate for Payer: Networks By Design Commercial |
$27.40
|
| Rate for Payer: Prime Health Services Commercial |
$35.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.40
|
| Rate for Payer: United Healthcare HMO Rider |
$15.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
|
|
HC SUPPORT ELBOW XLARGE
|
Facility
|
OP
|
$36.90
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607794
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.46
|
| Rate for Payer: Blue Shield of California Commercial |
$29.59
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$29.52
|
| Rate for Payer: Cigna of CA HMO |
$25.83
|
| Rate for Payer: Cigna of CA PPO |
$25.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$18.45
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.85
|
| Rate for Payer: United Healthcare All Other HMO |
$13.48
|
| Rate for Payer: United Healthcare HMO Rider |
$13.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.36
|
| Rate for Payer: Vantage Medical Group Senior |
$31.36
|
|
|
HC SUPPORT ELBOW XLARGE
|
Facility
|
IP
|
$36.90
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607794
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$33.21 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California Commercial |
$29.59
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$29.52
|
| Rate for Payer: Cigna of CA HMO |
$25.83
|
| Rate for Payer: Cigna of CA PPO |
$25.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$23.98
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.85
|
| Rate for Payer: United Healthcare All Other HMO |
$13.48
|
| Rate for Payer: United Healthcare HMO Rider |
$13.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.08
|
|
|
HC SUPPORTER ATHLETIC LARGE
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| 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 Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| 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 SUPPORTER ATHLETIC LARGE
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SUPPORTER ATHLETIC LRG 38-44"
|
Facility
|
OP
|
$35.59
|
|
| Hospital Charge Code |
901698455
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.03 |
| Rate for Payer: Adventist Health Commercial |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.56
|
| Rate for Payer: Blue Shield of California EPN |
$14.20
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| Rate for Payer: Cigna of CA HMO |
$22.78
|
| Rate for Payer: Cigna of CA PPO |
$26.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$30.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.91
|
| Rate for Payer: Multiplan Commercial |
$26.69
|
| Rate for Payer: Networks By Design Commercial |
$23.13
|
| Rate for Payer: Prime Health Services Commercial |
$30.25
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17.80
|
| Rate for Payer: United Healthcare HMO Rider |
$17.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Vantage Medical Group Senior |
$30.25
|
|
|
HC SUPPORTER ATHLETIC LRG 38-44"
|
Facility
|
IP
|
$35.59
|
|
| Hospital Charge Code |
901698455
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.03 |
| Rate for Payer: Adventist Health Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$30.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Multiplan Commercial |
$26.69
|
| Rate for Payer: Networks By Design Commercial |
$23.13
|
| Rate for Payer: Prime Health Services Commercial |
$30.25
|
|
|
HC SUPPORTER ATHLETIC MED 32-38"
|
Facility
|
OP
|
$35.59
|
|
| Hospital Charge Code |
901698454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.03 |
| Rate for Payer: Adventist Health Commercial |
$7.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.56
|
| Rate for Payer: Blue Shield of California EPN |
$14.20
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| Rate for Payer: Cigna of CA HMO |
$22.78
|
| Rate for Payer: Cigna of CA PPO |
$26.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$30.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.91
|
| Rate for Payer: Multiplan Commercial |
$26.69
|
| Rate for Payer: Networks By Design Commercial |
$23.13
|
| Rate for Payer: Prime Health Services Commercial |
$30.25
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17.80
|
| Rate for Payer: United Healthcare HMO Rider |
$17.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Vantage Medical Group Senior |
$30.25
|
|
|
HC SUPPORTER ATHLETIC MED 32-38"
|
Facility
|
IP
|
$35.59
|
|
| Hospital Charge Code |
901698454
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.03 |
| Rate for Payer: Adventist Health Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$30.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Multiplan Commercial |
$26.69
|
| Rate for Payer: Networks By Design Commercial |
$23.13
|
| Rate for Payer: Prime Health Services Commercial |
$30.25
|
|
|
HC SUPPORT KNEE HINGED LARGE
|
Facility
|
OP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606731
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$88.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.74
|
| Rate for Payer: Blue Shield of California Commercial |
$173.36
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Central Health Plan Commercial |
$172.93
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.31
|
| Rate for Payer: Multiplan Commercial |
$162.12
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: Riverside University Health System MISP |
$86.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.74
|
| Rate for Payer: Vantage Medical Group Senior |
$183.74
|
|
|
HC SUPPORT KNEE HINGED LARGE
|
Facility
|
IP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606731
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Blue Shield of California Commercial |
$173.36
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Central Health Plan Commercial |
$172.93
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.23
|
| Rate for Payer: Multiplan Commercial |
$162.12
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
|
|
HC SUPPORT KNEE HINGED MED.
|
Facility
|
IP
|
$228.06
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$205.25 |
| Rate for Payer: Adventist Health Commercial |
$45.61
|
| Rate for Payer: Blue Shield of California Commercial |
$182.90
|
| Rate for Payer: Blue Shield of California EPN |
$114.94
|
| Rate for Payer: Cash Price |
$102.63
|
| Rate for Payer: Central Health Plan Commercial |
$182.45
|
| Rate for Payer: Cigna of CA HMO |
$159.64
|
| Rate for Payer: Cigna of CA PPO |
$159.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.22
|
| Rate for Payer: EPIC Health Plan Senior |
$91.22
|
| Rate for Payer: Galaxy Health WC |
$193.85
|
| Rate for Payer: Global Benefits Group Commercial |
$136.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.61
|
| Rate for Payer: Multiplan Commercial |
$171.04
|
| Rate for Payer: Networks By Design Commercial |
$148.24
|
| Rate for Payer: Prime Health Services Commercial |
$193.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.59
|
| Rate for Payer: United Healthcare All Other HMO |
$83.31
|
| Rate for Payer: United Healthcare HMO Rider |
$81.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.69
|
|
|
HC SUPPORT KNEE HINGED MED.
|
Facility
|
OP
|
$228.06
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.69 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.66
|
| Rate for Payer: Blue Shield of California Commercial |
$182.90
|
| Rate for Payer: Blue Shield of California EPN |
$114.94
|
| Rate for Payer: Cash Price |
$102.63
|
| Rate for Payer: Cash Price |
$102.63
|
| Rate for Payer: Central Health Plan Commercial |
$182.45
|
| Rate for Payer: Cigna of CA HMO |
$159.64
|
| Rate for Payer: Cigna of CA PPO |
$159.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.22
|
| Rate for Payer: EPIC Health Plan Senior |
$91.22
|
| Rate for Payer: Galaxy Health WC |
$193.85
|
| Rate for Payer: Global Benefits Group Commercial |
$136.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$159.64
|
| Rate for Payer: Multiplan Commercial |
$171.04
|
| Rate for Payer: Networks By Design Commercial |
$114.03
|
| Rate for Payer: Prime Health Services Commercial |
$193.85
|
| Rate for Payer: Riverside University Health System MISP |
$91.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.59
|
| Rate for Payer: United Healthcare All Other HMO |
$83.31
|
| Rate for Payer: United Healthcare HMO Rider |
$81.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.85
|
| Rate for Payer: Vantage Medical Group Senior |
$193.85
|
|
|
HC SUPPORT KNEE HINGED X-LARGE
|
Facility
|
IP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606732
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Blue Shield of California Commercial |
$173.36
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Central Health Plan Commercial |
$172.93
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.23
|
| Rate for Payer: Multiplan Commercial |
$162.12
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
|
|
HC SUPPORT KNEE HINGED X-LARGE
|
Facility
|
OP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606732
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Adventist Health Commercial |
$88.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.74
|
| Rate for Payer: Blue Shield of California Commercial |
$173.36
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Central Health Plan Commercial |
$172.93
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.31
|
| Rate for Payer: Multiplan Commercial |
$162.12
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: Riverside University Health System MISP |
$86.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.74
|
| Rate for Payer: Vantage Medical Group Senior |
$183.74
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
IP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Adventist Health Commercial |
$35.84
|
| Rate for Payer: Blue Shield of California Commercial |
$143.72
|
| Rate for Payer: Blue Shield of California EPN |
$90.32
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Central Health Plan Commercial |
$143.36
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.84
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$116.48
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
OP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$972.99 |
| Rate for Payer: Adventist Health Commercial |
$73.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.24
|
| Rate for Payer: Blue Shield of California Commercial |
$143.72
|
| Rate for Payer: Blue Shield of California EPN |
$90.32
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Central Health Plan Commercial |
$143.36
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$880.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$972.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.44
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$89.60
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: Riverside University Health System MISP |
$71.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Vantage Medical Group Senior |
$152.32
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
IP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Central Health Plan Commercial |
$23.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$22.45
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
OP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.98
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Central Health Plan Commercial |
$23.94
|
| Rate for Payer: Cigna of CA HMO |
$19.16
|
| Rate for Payer: Cigna of CA PPO |
$22.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$22.45
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
| Rate for Payer: Riverside University Health System MISP |
$11.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.96
|
| Rate for Payer: United Healthcare All Other HMO |
$14.96
|
| Rate for Payer: United Healthcare HMO Rider |
$14.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: Vantage Medical Group Senior |
$25.44
|
|
|
HC SUPPORT SACRO LUMBAR XLG
|
Facility
|
IP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$129.07 |
| Rate for Payer: Adventist Health Commercial |
$28.68
|
| Rate for Payer: Blue Shield of California Commercial |
$115.01
|
| Rate for Payer: Blue Shield of California EPN |
$72.28
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Central Health Plan Commercial |
$114.73
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.36
|
| Rate for Payer: EPIC Health Plan Senior |
$57.36
|
| Rate for Payer: Galaxy Health WC |
$121.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.68
|
| Rate for Payer: Multiplan Commercial |
$107.56
|
| Rate for Payer: Networks By Design Commercial |
$93.22
|
| Rate for Payer: Prime Health Services Commercial |
$121.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.82
|
| Rate for Payer: United Healthcare All Other HMO |
$52.39
|
| Rate for Payer: United Healthcare HMO Rider |
$51.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.97
|
|
|
HC SUPPORT SACRO LUMBAR XLG
|
Facility
|
OP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.42
|
| Rate for Payer: Blue Shield of California Commercial |
$115.01
|
| Rate for Payer: Blue Shield of California EPN |
$72.28
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Central Health Plan Commercial |
$114.73
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.36
|
| Rate for Payer: EPIC Health Plan Senior |
$57.36
|
| Rate for Payer: Galaxy Health WC |
$121.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.39
|
| Rate for Payer: Multiplan Commercial |
$107.56
|
| Rate for Payer: Networks By Design Commercial |
$71.70
|
| Rate for Payer: Prime Health Services Commercial |
$121.90
|
| Rate for Payer: Riverside University Health System MISP |
$57.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.82
|
| Rate for Payer: United Healthcare All Other HMO |
$52.39
|
| Rate for Payer: United Healthcare HMO Rider |
$51.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.90
|
| Rate for Payer: Vantage Medical Group Senior |
$121.90
|
|
|
HC SUPPORT SWIMMER ADULT LG
|
Facility
|
IP
|
$38.21
|
|
| Hospital Charge Code |
901601319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
HC SUPPORT SWIMMER ADULT LG
|
Facility
|
OP
|
$38.21
|
|
| Hospital Charge Code |
901601319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.23
|
| Rate for Payer: Blue Shield of California Commercial |
$24.23
|
| Rate for Payer: Blue Shield of California EPN |
$15.25
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$24.45
|
| Rate for Payer: Cigna of CA PPO |
$28.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Riverside University Health System MISP |
$15.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19.11
|
| Rate for Payer: United Healthcare HMO Rider |
$19.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
HC SUPPORT SWIMMER ADULT MED
|
Facility
|
OP
|
$38.21
|
|
| Hospital Charge Code |
901601318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.23
|
| Rate for Payer: Blue Shield of California Commercial |
$24.23
|
| Rate for Payer: Blue Shield of California EPN |
$15.25
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$24.45
|
| Rate for Payer: Cigna of CA PPO |
$28.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Riverside University Health System MISP |
$15.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19.11
|
| Rate for Payer: United Healthcare HMO Rider |
$19.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
