|
HC SUDAN BLACK B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$82.55
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC SUMP TUBE VALVE ANTI REFLUX
|
Facility
|
IP
|
$43.05
|
|
| Hospital Charge Code |
901698825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Adventist Health Commercial |
$8.61
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Central Health Plan Commercial |
$34.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.22
|
| Rate for Payer: EPIC Health Plan Senior |
$17.22
|
| Rate for Payer: Galaxy Health WC |
$36.59
|
| Rate for Payer: Global Benefits Group Commercial |
$25.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$32.29
|
| Rate for Payer: Networks By Design Commercial |
$27.98
|
| Rate for Payer: Prime Health Services Commercial |
$36.59
|
|
|
HC SUMP TUBE VALVE ANTI REFLUX
|
Facility
|
OP
|
$43.05
|
|
| Hospital Charge Code |
901698825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Adventist Health Commercial |
$8.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.28
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Blue Shield of California EPN |
$17.18
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Central Health Plan Commercial |
$34.44
|
| Rate for Payer: Cigna of CA HMO |
$27.55
|
| Rate for Payer: Cigna of CA PPO |
$31.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.22
|
| Rate for Payer: EPIC Health Plan Senior |
$17.22
|
| Rate for Payer: Galaxy Health WC |
$36.59
|
| Rate for Payer: Global Benefits Group Commercial |
$25.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.74
|
| Rate for Payer: InnovAge PACE Commercial |
$21.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.14
|
| Rate for Payer: Multiplan Commercial |
$32.29
|
| Rate for Payer: Networks By Design Commercial |
$27.98
|
| Rate for Payer: Prime Health Services Commercial |
$36.59
|
| Rate for Payer: Riverside University Health System MISP |
$17.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.52
|
| Rate for Payer: United Healthcare HMO Rider |
$21.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.59
|
| Rate for Payer: Vantage Medical Group Senior |
$36.59
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Adventist Health Commercial |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.72
|
| Rate for Payer: Blue Shield of California Commercial |
$65.44
|
| Rate for Payer: Blue Shield of California EPN |
$42.67
|
| Rate for Payer: Cash Price |
$46.56
|
| Rate for Payer: Cash Price |
$46.56
|
| Rate for Payer: Central Health Plan Commercial |
$67.73
|
| Rate for Payer: Cigna of CA HMO |
$59.26
|
| Rate for Payer: Cigna of CA PPO |
$59.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.86
|
| Rate for Payer: EPIC Health Plan Senior |
$33.86
|
| Rate for Payer: Galaxy Health WC |
$71.96
|
| Rate for Payer: Global Benefits Group Commercial |
$50.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: InnovAge PACE Commercial |
$42.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.26
|
| Rate for Payer: Multiplan Commercial |
$63.49
|
| Rate for Payer: Networks By Design Commercial |
$42.33
|
| Rate for Payer: Prime Health Services Commercial |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$33.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.96
|
| Rate for Payer: Vantage Medical Group Senior |
$71.96
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Adventist Health Commercial |
$16.93
|
| Rate for Payer: Blue Shield of California Commercial |
$65.44
|
| Rate for Payer: Blue Shield of California EPN |
$42.67
|
| Rate for Payer: Cash Price |
$46.56
|
| Rate for Payer: Central Health Plan Commercial |
$67.73
|
| Rate for Payer: Cigna of CA HMO |
$59.26
|
| Rate for Payer: Cigna of CA PPO |
$59.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.86
|
| Rate for Payer: EPIC Health Plan Senior |
$33.86
|
| Rate for Payer: Galaxy Health WC |
$71.96
|
| Rate for Payer: Global Benefits Group Commercial |
$50.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$63.49
|
| Rate for Payer: Networks By Design Commercial |
$55.03
|
| Rate for Payer: Prime Health Services Commercial |
$71.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.73
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
|
OP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.11 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Adventist Health Commercial |
$52.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.52
|
| Rate for Payer: Blue Shield of California Commercial |
$99.40
|
| Rate for Payer: Blue Shield of California EPN |
$64.81
|
| Rate for Payer: Cash Price |
$70.72
|
| Rate for Payer: Cash Price |
$70.72
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Senior |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: InnovAge PACE Commercial |
$64.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.01
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$64.30
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: Riverside University Health System MISP |
$51.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.26
|
| Rate for Payer: United Healthcare All Other HMO |
$46.97
|
| Rate for Payer: United Healthcare HMO Rider |
$45.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.30
|
| Rate for Payer: Vantage Medical Group Senior |
$109.30
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
|
IP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Adventist Health Commercial |
$25.72
|
| Rate for Payer: Blue Shield of California Commercial |
$99.40
|
| Rate for Payer: Blue Shield of California EPN |
$64.81
|
| Rate for Payer: Cash Price |
$70.72
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Senior |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.26
|
| Rate for Payer: United Healthcare All Other HMO |
$46.97
|
| Rate for Payer: United Healthcare HMO Rider |
$45.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.11
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Blue Shield of California Commercial |
$205.19
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$108.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.89
|
| Rate for Payer: Blue Shield of California Commercial |
$205.19
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: InnovAge PACE Commercial |
$132.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health System MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
OP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Adventist Health Commercial |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.92
|
| Rate for Payer: Blue Shield of California Commercial |
$77.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.56
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: InnovAge PACE Commercial |
$50.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.22
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: Riverside University Health System MISP |
$40.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.27
|
| Rate for Payer: Vantage Medical Group Senior |
$85.27
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
IP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$90.29 |
| Rate for Payer: Adventist Health Commercial |
$20.06
|
| Rate for Payer: Blue Shield of California Commercial |
$77.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.56
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$65.21
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.95
|
| Rate for Payer: Blue Shield of California Commercial |
$114.44
|
| Rate for Payer: Blue Shield of California EPN |
$74.62
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.13
|
| Rate for Payer: InnovAge PACE Commercial |
$74.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$74.03
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: Riverside University Health System MISP |
$59.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.84
|
| Rate for Payer: Vantage Medical Group Senior |
$125.84
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Adventist Health Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California Commercial |
$114.44
|
| Rate for Payer: Blue Shield of California EPN |
$74.62
|
| Rate for Payer: Cash Price |
$81.43
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.61
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$96.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
|
|
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 |
$32.58
|
| Rate for Payer: Blue Shield of California EPN |
$21.24
|
| Rate for Payer: Cash Price |
$23.18
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.09
|
| 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 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 |
$24.75
|
| Rate for Payer: Blue Shield of California Commercial |
$32.58
|
| Rate for Payer: Blue Shield of California EPN |
$21.24
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| 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: 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: InnovAge PACE Commercial |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.50
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$28.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Cash Price |
$20.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.84
|
| 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 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 |
$21.67
|
| Rate for Payer: Blue Shield of California Commercial |
$28.52
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| 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: 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: InnovAge PACE Commercial |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.83
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$20.90
|
| Rate for Payer: Blue Shield of California Commercial |
$21.75
|
| Rate for Payer: Blue Shield of California EPN |
$14.20
|
| Rate for Payer: Cash Price |
$19.57
|
| 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: 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: InnovAge PACE Commercial |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.91
|
| Rate for Payer: Molina Healthcare of CA 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 |
$19.57
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| 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 Permanente of CA Commercial/Self Funded |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.03
|
| 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
|
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 |
$19.57
|
| Rate for Payer: Central Health Plan Commercial |
$28.47
|
| 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 Permanente of CA Commercial/Self Funded |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.03
|
| 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 |
$20.90
|
| Rate for Payer: Blue Shield of California Commercial |
$21.75
|
| Rate for Payer: Blue Shield of California EPN |
$14.20
|
| Rate for Payer: Cash Price |
$19.57
|
| 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: 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: InnovAge PACE Commercial |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.91
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$167.09
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$118.89
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| 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 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 |
$126.95
|
| Rate for Payer: Blue Shield of California Commercial |
$167.09
|
| Rate for Payer: Blue Shield of California EPN |
$108.94
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| 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: 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: InnovAge PACE Commercial |
$108.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.31
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$176.29
|
| Rate for Payer: Blue Shield of California EPN |
$114.94
|
| Rate for Payer: Cash Price |
$125.43
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$152.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.17
|
| 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 |
$133.94
|
| Rate for Payer: Blue Shield of California Commercial |
$176.29
|
| Rate for Payer: Blue Shield of California EPN |
$114.94
|
| Rate for Payer: Cash Price |
$125.43
|
| Rate for Payer: Cash Price |
$125.43
|
| 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: 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: InnovAge PACE Commercial |
$114.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.64
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
