|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.04 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$839.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,190.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.69
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$839.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Riverside University Health System MISP |
$818.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC BRACE LUMBAR XXXLG LCIT
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
901692018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.69
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,432.90
|
| Rate for Payer: Cigna of CA PPO |
$1,432.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.24
|
| Rate for Payer: United Healthcare All Other HMO |
$747.77
|
| Rate for Payer: United Healthcare HMO Rider |
$731.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.39
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
IP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Adventist Health Commercial |
$62.45
|
| Rate for Payer: Blue Shield of California Commercial |
$250.44
|
| Rate for Payer: Blue Shield of California EPN |
$157.38
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Central Health Plan Commercial |
$249.82
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.45
|
| Rate for Payer: Multiplan Commercial |
$234.20
|
| Rate for Payer: Networks By Design Commercial |
$202.98
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
|
|
HC BRACE SHLDR ULTRASLING III MED
|
Facility
|
OP
|
$312.27
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901698172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Adventist Health Commercial |
$128.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.65
|
| Rate for Payer: Blue Shield of California Commercial |
$250.44
|
| Rate for Payer: Blue Shield of California EPN |
$157.38
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Cash Price |
$140.52
|
| Rate for Payer: Central Health Plan Commercial |
$249.82
|
| Rate for Payer: Cigna of CA HMO |
$218.59
|
| Rate for Payer: Cigna of CA PPO |
$218.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Senior |
$124.91
|
| Rate for Payer: Galaxy Health WC |
$265.43
|
| Rate for Payer: Global Benefits Group Commercial |
$187.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$218.59
|
| Rate for Payer: Multiplan Commercial |
$234.20
|
| Rate for Payer: Networks By Design Commercial |
$156.13
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: Riverside University Health System MISP |
$124.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.19
|
| Rate for Payer: United Healthcare All Other HMO |
$114.07
|
| Rate for Payer: United Healthcare HMO Rider |
$111.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.43
|
| Rate for Payer: Vantage Medical Group Senior |
$265.43
|
|
|
HC BRACE, THUMB CURAD UNIVERSAL
|
Facility
|
OP
|
$55.27
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$49.74 |
| Rate for Payer: Adventist Health Commercial |
$22.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.86
|
| Rate for Payer: Cash Price |
$24.87
|
| Rate for Payer: Cash Price |
$24.87
|
| Rate for Payer: Central Health Plan Commercial |
$44.22
|
| Rate for Payer: Cigna of CA HMO |
$38.69
|
| Rate for Payer: Cigna of CA PPO |
$38.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: EPIC Health Plan Senior |
$22.11
|
| Rate for Payer: Galaxy Health WC |
$46.98
|
| Rate for Payer: Global Benefits Group Commercial |
$33.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.69
|
| Rate for Payer: Multiplan Commercial |
$41.45
|
| Rate for Payer: Networks By Design Commercial |
$27.64
|
| Rate for Payer: Prime Health Services Commercial |
$46.98
|
| Rate for Payer: Riverside University Health System MISP |
$22.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.74
|
| Rate for Payer: United Healthcare All Other HMO |
$20.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.98
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC BRACE, THUMB CURAD UNIVERSAL
|
Facility
|
IP
|
$55.27
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$49.74 |
| Rate for Payer: Adventist Health Commercial |
$11.05
|
| Rate for Payer: Blue Shield of California Commercial |
$44.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.86
|
| Rate for Payer: Cash Price |
$24.87
|
| Rate for Payer: Central Health Plan Commercial |
$44.22
|
| Rate for Payer: Cigna of CA HMO |
$38.69
|
| Rate for Payer: Cigna of CA PPO |
$38.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: EPIC Health Plan Senior |
$22.11
|
| Rate for Payer: Galaxy Health WC |
$46.98
|
| Rate for Payer: Global Benefits Group Commercial |
$33.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.05
|
| Rate for Payer: Multiplan Commercial |
$41.45
|
| Rate for Payer: Networks By Design Commercial |
$35.93
|
| Rate for Payer: Prime Health Services Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.74
|
| Rate for Payer: United Healthcare All Other HMO |
$20.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
|
|
HC BRACE THUMB UNIVERSAL
|
Facility
|
IP
|
$113.01
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
901607804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.71 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.96
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.41
|
| Rate for Payer: Cigna of CA HMO |
$79.11
|
| Rate for Payer: Cigna of CA PPO |
$79.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.06
|
| Rate for Payer: Global Benefits Group Commercial |
$67.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.76
|
| Rate for Payer: Networks By Design Commercial |
$73.46
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BRACE THUMB UNIVERSAL
|
Facility
|
OP
|
$113.01
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
901607804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$101.71 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.74
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.96
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.41
|
| Rate for Payer: Cigna of CA HMO |
$79.11
|
| Rate for Payer: Cigna of CA PPO |
$79.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.06
|
| Rate for Payer: Global Benefits Group Commercial |
$67.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.11
|
| Rate for Payer: Multiplan Commercial |
$84.76
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.06
|
| Rate for Payer: Vantage Medical Group Senior |
$96.06
|
|
|
HC BRACE, THUMB UNIVERSAL
|
Facility
|
OP
|
$55.68
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698531
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Adventist Health Commercial |
$22.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.39
|
| Rate for Payer: Blue Shield of California Commercial |
$44.66
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Central Health Plan Commercial |
$44.54
|
| Rate for Payer: Cigna of CA HMO |
$38.98
|
| Rate for Payer: Cigna of CA PPO |
$38.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.27
|
| Rate for Payer: Galaxy Health WC |
$47.33
|
| Rate for Payer: Global Benefits Group Commercial |
$33.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.98
|
| Rate for Payer: Multiplan Commercial |
$41.76
|
| Rate for Payer: Networks By Design Commercial |
$27.84
|
| Rate for Payer: Prime Health Services Commercial |
$47.33
|
| Rate for Payer: Riverside University Health System MISP |
$22.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.33
|
| Rate for Payer: Vantage Medical Group Senior |
$47.33
|
|
|
HC BRACE, THUMB UNIVERSAL
|
Facility
|
IP
|
$55.68
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698531
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Adventist Health Commercial |
$11.14
|
| Rate for Payer: Blue Shield of California Commercial |
$44.66
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Central Health Plan Commercial |
$44.54
|
| Rate for Payer: Cigna of CA HMO |
$38.98
|
| Rate for Payer: Cigna of CA PPO |
$38.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.27
|
| Rate for Payer: Galaxy Health WC |
$47.33
|
| Rate for Payer: Global Benefits Group Commercial |
$33.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$41.76
|
| Rate for Payer: Networks By Design Commercial |
$36.19
|
| Rate for Payer: Prime Health Services Commercial |
$47.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.24
|
|
|
HC BRACE, THUMB UNIV W/ADJ STRAPS
|
Facility
|
OP
|
$58.47
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Adventist Health Commercial |
$23.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.01
|
| Rate for Payer: Blue Shield of California Commercial |
$46.89
|
| Rate for Payer: Blue Shield of California EPN |
$29.47
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Central Health Plan Commercial |
$46.78
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$40.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Senior |
$23.39
|
| Rate for Payer: Galaxy Health WC |
$49.70
|
| Rate for Payer: Global Benefits Group Commercial |
$35.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.93
|
| Rate for Payer: Multiplan Commercial |
$43.85
|
| Rate for Payer: Networks By Design Commercial |
$29.23
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
| Rate for Payer: Riverside University Health System MISP |
$23.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.70
|
| Rate for Payer: Vantage Medical Group Senior |
$49.70
|
|
|
HC BRACE, THUMB UNIV W/ADJ STRAPS
|
Facility
|
IP
|
$58.47
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Adventist Health Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$46.89
|
| Rate for Payer: Blue Shield of California EPN |
$29.47
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: Central Health Plan Commercial |
$46.78
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$40.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Senior |
$23.39
|
| Rate for Payer: Galaxy Health WC |
$49.70
|
| Rate for Payer: Global Benefits Group Commercial |
$35.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$43.85
|
| Rate for Payer: Networks By Design Commercial |
$38.01
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
|
|
HC BRACE WRIST LFT SUPPORT WRAP
|
Facility
|
IP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$46.42 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$41.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Central Health Plan Commercial |
$41.26
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$38.69
|
| Rate for Payer: Networks By Design Commercial |
$33.53
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
|
|
HC BRACE WRIST LFT SUPPORT WRAP
|
Facility
|
OP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Central Health Plan Commercial |
$41.26
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.11
|
| Rate for Payer: Multiplan Commercial |
$38.69
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Riverside University Health System MISP |
$20.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$43.84
|
|
|
HC BRACE WRIST RT SUPPORT WRAP
|
Facility
|
IP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698592
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$46.42 |
| Rate for Payer: Adventist Health Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$41.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Central Health Plan Commercial |
$41.26
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$38.69
|
| Rate for Payer: Networks By Design Commercial |
$33.53
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
|
|
HC BRACE WRIST RT SUPPORT WRAP
|
Facility
|
OP
|
$51.58
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698592
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Central Health Plan Commercial |
$41.26
|
| Rate for Payer: Cigna of CA HMO |
$36.11
|
| Rate for Payer: Cigna of CA PPO |
$36.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Senior |
$20.63
|
| Rate for Payer: Galaxy Health WC |
$43.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.11
|
| Rate for Payer: Multiplan Commercial |
$38.69
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Riverside University Health System MISP |
$20.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.36
|
| Rate for Payer: United Healthcare All Other HMO |
$18.84
|
| Rate for Payer: United Healthcare HMO Rider |
$18.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$43.84
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
|
IP
|
$75.03
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Adventist Health Commercial |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$60.17
|
| Rate for Payer: Blue Shield of California EPN |
$37.82
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Central Health Plan Commercial |
$60.02
|
| Rate for Payer: Cigna of CA HMO |
$52.52
|
| Rate for Payer: Cigna of CA PPO |
$52.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$30.01
|
| Rate for Payer: Galaxy Health WC |
$63.78
|
| Rate for Payer: Global Benefits Group Commercial |
$45.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.01
|
| Rate for Payer: Multiplan Commercial |
$56.27
|
| Rate for Payer: Networks By Design Commercial |
$48.77
|
| Rate for Payer: Prime Health Services Commercial |
$63.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.16
|
| Rate for Payer: United Healthcare All Other HMO |
$27.41
|
| Rate for Payer: United Healthcare HMO Rider |
$26.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.57
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
|
OP
|
$75.03
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$30.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.64
|
| Rate for Payer: Blue Shield of California Commercial |
$60.17
|
| Rate for Payer: Blue Shield of California EPN |
$37.82
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Central Health Plan Commercial |
$60.02
|
| Rate for Payer: Cigna of CA HMO |
$52.52
|
| Rate for Payer: Cigna of CA PPO |
$52.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$30.01
|
| Rate for Payer: Galaxy Health WC |
$63.78
|
| Rate for Payer: Global Benefits Group Commercial |
$45.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.52
|
| Rate for Payer: Multiplan Commercial |
$56.27
|
| Rate for Payer: Networks By Design Commercial |
$37.52
|
| Rate for Payer: Prime Health Services Commercial |
$63.78
|
| Rate for Payer: Riverside University Health System MISP |
$30.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.16
|
| Rate for Payer: United Healthcare All Other HMO |
$27.41
|
| Rate for Payer: United Healthcare HMO Rider |
$26.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.78
|
| Rate for Payer: Vantage Medical Group Senior |
$63.78
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
|
IP
|
$78.23
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$70.41 |
| Rate for Payer: Adventist Health Commercial |
$15.65
|
| Rate for Payer: Blue Shield of California Commercial |
$62.74
|
| Rate for Payer: Blue Shield of California EPN |
$39.43
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$62.58
|
| Rate for Payer: Cigna of CA HMO |
$54.76
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.29
|
| Rate for Payer: EPIC Health Plan Senior |
$31.29
|
| Rate for Payer: Galaxy Health WC |
$66.50
|
| Rate for Payer: Global Benefits Group Commercial |
$46.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$58.67
|
| Rate for Payer: Networks By Design Commercial |
$50.85
|
| Rate for Payer: Prime Health Services Commercial |
$66.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.36
|
| Rate for Payer: United Healthcare All Other HMO |
$28.58
|
| Rate for Payer: United Healthcare HMO Rider |
$27.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.62
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
|
OP
|
$78.23
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$32.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.51
|
| Rate for Payer: Blue Shield of California Commercial |
$62.74
|
| Rate for Payer: Blue Shield of California EPN |
$39.43
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$62.58
|
| Rate for Payer: Cigna of CA HMO |
$54.76
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.29
|
| Rate for Payer: EPIC Health Plan Senior |
$31.29
|
| Rate for Payer: Galaxy Health WC |
$66.50
|
| Rate for Payer: Global Benefits Group Commercial |
$46.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.76
|
| Rate for Payer: Multiplan Commercial |
$58.67
|
| Rate for Payer: Networks By Design Commercial |
$39.12
|
| Rate for Payer: Prime Health Services Commercial |
$66.50
|
| Rate for Payer: Riverside University Health System MISP |
$31.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.36
|
| Rate for Payer: United Healthcare All Other HMO |
$28.58
|
| Rate for Payer: United Healthcare HMO Rider |
$27.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.50
|
| Rate for Payer: Vantage Medical Group Senior |
$66.50
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$6,870.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,374.00 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,809.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,748.00
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,183.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,362.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,053.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$5,152.50
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$6,870.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$481.58 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,223.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,027.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,328.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,727.39
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| Rate for Payer: Cigna of CA HMO |
$4,396.80
|
| Rate for Payer: Cigna of CA PPO |
$5,083.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,809.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,183.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,362.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$5,152.50
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
IP
|
$6,870.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,374.00 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,809.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,748.00
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,183.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,362.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,053.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$5,152.50
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
OP
|
$6,870.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$481.58 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,223.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,027.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,328.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,727.39
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| Rate for Payer: Cigna of CA HMO |
$4,396.80
|
| Rate for Payer: Cigna of CA PPO |
$5,083.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,809.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,183.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,362.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$5,152.50
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
IP
|
$6,284.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,256.80 |
| Max. Negotiated Rate |
$5,655.60 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,398.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,513.60
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,990.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,707.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
|
