|
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 |
$32.46
|
| Rate for Payer: Blue Shield of California Commercial |
$42.72
|
| Rate for Payer: Blue Shield of California EPN |
$27.86
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| 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: 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: InnovAge PACE Commercial |
$27.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.69
|
| Rate for Payer: Molina Healthcare of CA 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 |
$42.72
|
| Rate for Payer: Blue Shield of California EPN |
$27.86
|
| Rate for Payer: Cash Price |
$30.40
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$36.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.21
|
| 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
|
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 |
$66.37
|
| Rate for Payer: Blue Shield of California Commercial |
$87.36
|
| Rate for Payer: Blue Shield of California EPN |
$56.96
|
| Rate for Payer: Cash Price |
$62.16
|
| 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: 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: InnovAge PACE Commercial |
$56.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.11
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$87.36
|
| Rate for Payer: Blue Shield of California EPN |
$56.96
|
| Rate for Payer: Cash Price |
$62.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$75.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| 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
|
$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 |
$32.70
|
| Rate for Payer: Blue Shield of California Commercial |
$43.04
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cash Price |
$30.62
|
| 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: 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: InnovAge PACE Commercial |
$27.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.98
|
| Rate for Payer: Molina Healthcare of CA 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 |
$43.04
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$30.62
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$37.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.47
|
| 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
|
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 |
$45.20
|
| Rate for Payer: Blue Shield of California EPN |
$29.47
|
| Rate for Payer: Cash Price |
$32.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.19
|
| 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, 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 |
$34.34
|
| Rate for Payer: Blue Shield of California Commercial |
$45.20
|
| Rate for Payer: Blue Shield of California EPN |
$29.47
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Cash Price |
$32.16
|
| 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: 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: InnovAge PACE Commercial |
$29.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.93
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$30.29
|
| Rate for Payer: Blue Shield of California Commercial |
$39.87
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$28.37
|
| Rate for Payer: Cash Price |
$28.37
|
| 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: 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: InnovAge PACE Commercial |
$25.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.11
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$39.87
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$28.37
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| 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 |
$30.29
|
| Rate for Payer: Blue Shield of California Commercial |
$39.87
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$28.37
|
| Rate for Payer: Cash Price |
$28.37
|
| 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: 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: InnovAge PACE Commercial |
$25.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.11
|
| Rate for Payer: Molina Healthcare of CA 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 |
$39.87
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$28.37
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.93
|
| 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 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 |
$44.07
|
| Rate for Payer: Blue Shield of California Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California EPN |
$37.82
|
| Rate for Payer: Cash Price |
$41.27
|
| Rate for Payer: Cash Price |
$41.27
|
| 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: 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: InnovAge PACE Commercial |
$37.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.52
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$58.00
|
| Rate for Payer: Blue Shield of California EPN |
$37.82
|
| Rate for Payer: Cash Price |
$41.27
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$50.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.44
|
| 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 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 |
$60.47
|
| Rate for Payer: Blue Shield of California EPN |
$39.43
|
| Rate for Payer: Cash Price |
$43.03
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$52.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.42
|
| 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 |
$45.94
|
| Rate for Payer: Blue Shield of California Commercial |
$60.47
|
| Rate for Payer: Blue Shield of California EPN |
$39.43
|
| Rate for Payer: Cash Price |
$43.03
|
| Rate for Payer: Cash Price |
$43.03
|
| 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: 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: InnovAge PACE Commercial |
$39.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.76
|
| Rate for Payer: Molina Healthcare of CA 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 |
$3,778.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,252.53
|
| 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 |
$295.98 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,172.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,170.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,727.39
|
| Rate for Payer: Cash Price |
$3,778.50
|
| Rate for Payer: Cash Price |
$3,778.50
|
| Rate for Payer: Cash Price |
$3,778.50
|
| 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 |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| 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 |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| 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 |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| 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 |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
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 |
$295.98 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,172.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,170.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,727.39
|
| Rate for Payer: Cash Price |
$3,778.50
|
| Rate for Payer: Cash Price |
$3,778.50
|
| Rate for Payer: Cash Price |
$3,778.50
|
| 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 |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| 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 |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| 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 |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| 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 |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
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 |
$3,778.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,252.53
|
| 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 INTERMEDIATE
|
Facility
|
OP
|
$6,284.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$218.07 |
| Max. Negotiated Rate |
$5,655.60 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,816.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,074.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3,814.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,494.75
|
| Rate for Payer: Cash Price |
$3,456.20
|
| Rate for Payer: Cash Price |
$3,456.20
|
| Rate for Payer: Cash Price |
$3,456.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Cigna of CA HMO |
$4,021.76
|
| Rate for Payer: Cigna of CA PPO |
$4,650.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| 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: Heritage Provider Network Commercial/Senior |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$373.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,770.40
|
| 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 |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
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 |
$3,456.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| 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 Permanente of CA Commercial/Self Funded |
$4,191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,889.80
|
| 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
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$5,503.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,100.60 |
| Max. Negotiated Rate |
$4,952.70 |
| Rate for Payer: Adventist Health Commercial |
$1,100.60
|
| Rate for Payer: Cash Price |
$3,026.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,201.20
|
| Rate for Payer: Galaxy Health WC |
$4,677.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,952.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,096.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,406.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.60
|
| Rate for Payer: Multiplan Commercial |
$4,127.25
|
| Rate for Payer: Networks By Design Commercial |
$3,576.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,677.55
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$5,503.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$167.26 |
| Max. Negotiated Rate |
$4,952.70 |
| Rate for Payer: Adventist Health Commercial |
$1,100.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,341.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$824.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,340.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,184.69
|
| Rate for Payer: Cash Price |
$3,026.65
|
| Rate for Payer: Cash Price |
$3,026.65
|
| Rate for Payer: Cash Price |
$3,026.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,402.40
|
| Rate for Payer: Cigna of CA HMO |
$3,521.92
|
| Rate for Payer: Cigna of CA PPO |
$4,072.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$4,677.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,952.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$286.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$4,127.25
|
| Rate for Payer: Networks By Design Commercial |
$3,576.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,677.55
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,301.80
|
| 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 |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC BRAF
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.68
|
| Rate for Payer: Blue Shield of California Commercial |
$281.65
|
| Rate for Payer: Blue Shield of California EPN |
$184.21
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.79
|
| Rate for Payer: EPIC Health Plan Senior |
$175.40
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: InnovAge PACE Commercial |
$263.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.07
|
| Rate for Payer: United Healthcare All Other HMO |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
