|
HC BRACE ANKLE GEL UNIV
|
Facility
OP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$371.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$98.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$98.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.24
|
| Rate for Payer: BCBS Transplant Transplant |
$107.90
|
| Rate for Payer: Blue Shield of California Commercial |
$134.87
|
| Rate for Payer: Blue Shield of California EPN |
$97.83
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Central Health Plan Commercial |
$143.86
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$134.87
|
| Rate for Payer: IEHP medi-cal |
$62.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Multiplan Commercial |
$134.87
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: Riverside University Health MISP |
$71.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.92
|
| Rate for Payer: United Healthcare All Other HMO |
$89.92
|
| Rate for Payer: United Healthcare HMO Rider |
$89.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.86
|
| Rate for Payer: Vantage Medical Group Senior |
$152.86
|
|
|
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: Blue Shield of California EPN |
$1,093.10
|
| 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: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,365.35
|
| 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 |
$1,023.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
|
|
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 |
$663.82 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$663.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,125.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$991.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,209.37
|
| Rate for Payer: BCBS Transplant Transplant |
$1,228.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.57
|
| 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: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,535.25
|
| Rate for Payer: IEHP medi-cal |
$716.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$839.27
|
| 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 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 |
$1,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
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: Blue Shield of California EPN |
$166.75
|
| 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: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$208.28
|
| 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 |
$156.14
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
|
|
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 |
$109.29 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$246.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$265.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.49
|
| Rate for Payer: BCBS Transplant Transplant |
$187.36
|
| Rate for Payer: Blue Shield of California Commercial |
$234.20
|
| Rate for Payer: Blue Shield of California EPN |
$169.87
|
| 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: EPIC Health Plan Commercial |
$124.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$234.20
|
| Rate for Payer: IEHP medi-cal |
$109.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.03
|
| Rate for Payer: Multiplan Commercial |
$234.20
|
| Rate for Payer: Networks By Design Commercial |
$156.14
|
| Rate for Payer: Prime Health Services Commercial |
$265.43
|
| Rate for Payer: Riverside University Health 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 |
$156.14
|
| Rate for Payer: United Healthcare All Other HMO |
$156.14
|
| Rate for Payer: United Healthcare HMO Rider |
$156.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.14
|
| 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
|
$59.12
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$353.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$353.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.93
|
| Rate for Payer: BCBS Transplant Transplant |
$35.47
|
| Rate for Payer: Blue Shield of California Commercial |
$44.34
|
| Rate for Payer: Blue Shield of California EPN |
$32.16
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.30
|
| Rate for Payer: Cigna of CA HMO |
$41.38
|
| Rate for Payer: Cigna of CA PPO |
$41.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.65
|
| Rate for Payer: Galaxy Health WC |
$50.25
|
| Rate for Payer: Global Benefits Group Commercial |
$35.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.34
|
| Rate for Payer: IEHP medi-cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$44.34
|
| Rate for Payer: Networks By Design Commercial |
$29.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.25
|
| Rate for Payer: Riverside University Health MISP |
$23.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.56
|
| Rate for Payer: United Healthcare All Other HMO |
$29.56
|
| Rate for Payer: United Healthcare HMO Rider |
$29.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.25
|
| Rate for Payer: Vantage Medical Group Senior |
$50.25
|
|
|
HC BRACE, THUMB CURAD UNIVERSAL
|
Facility
IP
|
$59.12
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698738
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Blue Shield of California EPN |
$31.57
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.30
|
| Rate for Payer: Cigna of CA HMO |
$41.38
|
| Rate for Payer: Cigna of CA PPO |
$41.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.65
|
| Rate for Payer: Galaxy Health WC |
$50.25
|
| Rate for Payer: Global Benefits Group Commercial |
$35.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$44.34
|
| Rate for Payer: Networks By Design Commercial |
$29.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.25
|
|
|
HC BRACE THUMB UNIVERSAL
|
Facility
OP
|
$113.01
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
901607804
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$902.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$902.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.77
|
| Rate for Payer: BCBS Transplant Transplant |
$67.81
|
| Rate for Payer: Blue Shield of California Commercial |
$84.76
|
| Rate for Payer: Blue Shield of California EPN |
$61.48
|
| Rate for Payer: Cash Price |
$50.85
|
| 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: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$84.76
|
| Rate for Payer: IEHP medi-cal |
$39.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$84.76
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
| Rate for Payer: Riverside University Health 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 |
$56.50
|
| Rate for Payer: United Healthcare All Other HMO |
$56.50
|
| Rate for Payer: United Healthcare HMO Rider |
$56.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.50
|
| 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: Blue Shield of California EPN |
$60.35
|
| 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: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.76
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.06
|
|
|
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: Blue Shield of California EPN |
$29.73
|
| 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: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$11.14
|
| 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
|
|
|
HC BRACE, THUMB UNIVERSAL
|
Facility
OP
|
$55.68
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
901698531
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$353.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$353.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.90
|
| Rate for Payer: BCBS Transplant Transplant |
$33.41
|
| Rate for Payer: Blue Shield of California Commercial |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$30.29
|
| 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: EPIC Health Plan Commercial |
$22.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$41.76
|
| Rate for Payer: IEHP medi-cal |
$19.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.83
|
| 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 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 |
$27.84
|
| Rate for Payer: United Healthcare All Other HMO |
$27.84
|
| Rate for Payer: United Healthcare HMO Rider |
$27.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.33
|
| Rate for Payer: Vantage Medical Group Senior |
$47.33
|
|
|
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: Blue Shield of California EPN |
$31.22
|
| 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: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$43.85
|
| Rate for Payer: Networks By Design Commercial |
$29.24
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
|
|
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 |
$20.46 |
| Max. Negotiated Rate |
$353.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$353.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: BCBS Transplant Transplant |
$35.08
|
| Rate for Payer: Blue Shield of California Commercial |
$43.85
|
| Rate for Payer: Blue Shield of California EPN |
$31.81
|
| 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: EPIC Health Plan Commercial |
$23.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$43.85
|
| Rate for Payer: IEHP medi-cal |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Multiplan Commercial |
$43.85
|
| Rate for Payer: Networks By Design Commercial |
$29.24
|
| Rate for Payer: Prime Health Services Commercial |
$49.70
|
| Rate for Payer: Riverside University Health 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 |
$29.24
|
| Rate for Payer: United Healthcare All Other HMO |
$29.24
|
| Rate for Payer: United Healthcare HMO Rider |
$29.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.24
|
| 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 |
$18.05 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.47
|
| Rate for Payer: BCBS Transplant Transplant |
$30.95
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| 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: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$38.68
|
| Rate for Payer: IEHP medi-cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Riverside University Health 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 |
$25.79
|
| Rate for Payer: United Healthcare All Other HMO |
$25.79
|
| Rate for Payer: United Healthcare HMO Rider |
$25.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.79
|
| 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: Blue Shield of California EPN |
$27.54
|
| 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: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
|
|
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 |
$18.05 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.47
|
| Rate for Payer: BCBS Transplant Transplant |
$30.95
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| 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: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$38.68
|
| Rate for Payer: IEHP medi-cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
| Rate for Payer: Riverside University Health 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 |
$25.79
|
| Rate for Payer: United Healthcare All Other HMO |
$25.79
|
| Rate for Payer: United Healthcare HMO Rider |
$25.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.79
|
| 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: Blue Shield of California EPN |
$27.54
|
| 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: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$38.68
|
| Rate for Payer: Networks By Design Commercial |
$25.79
|
| Rate for Payer: Prime Health Services Commercial |
$43.84
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
OP
|
$75.19
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.42
|
| Rate for Payer: BCBS Transplant Transplant |
$45.11
|
| Rate for Payer: Blue Shield of California Commercial |
$56.39
|
| Rate for Payer: Blue Shield of California EPN |
$40.90
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Central Health Plan Commercial |
$60.15
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.08
|
| Rate for Payer: Galaxy Health WC |
$63.91
|
| Rate for Payer: Global Benefits Group Commercial |
$45.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.39
|
| Rate for Payer: IEHP medi-cal |
$26.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.83
|
| Rate for Payer: Multiplan Commercial |
$56.39
|
| Rate for Payer: Networks By Design Commercial |
$37.60
|
| Rate for Payer: Prime Health Services Commercial |
$63.91
|
| Rate for Payer: Riverside University Health MISP |
$30.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.60
|
| Rate for Payer: United Healthcare All Other HMO |
$37.60
|
| Rate for Payer: United Healthcare HMO Rider |
$37.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.91
|
| Rate for Payer: Vantage Medical Group Senior |
$63.91
|
|
|
HC BRACE WRIST UNIVERSAL LFT WRAP
|
Facility
IP
|
$75.19
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607657
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$67.67 |
| Rate for Payer: Blue Shield of California EPN |
$40.15
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Central Health Plan Commercial |
$60.15
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$52.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.08
|
| Rate for Payer: Galaxy Health WC |
$63.91
|
| Rate for Payer: Global Benefits Group Commercial |
$45.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$56.39
|
| Rate for Payer: Networks By Design Commercial |
$37.60
|
| Rate for Payer: Prime Health Services Commercial |
$63.91
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
OP
|
$78.39
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.31
|
| Rate for Payer: BCBS Transplant Transplant |
$47.03
|
| Rate for Payer: Blue Shield of California Commercial |
$58.79
|
| Rate for Payer: Blue Shield of California EPN |
$42.64
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Central Health Plan Commercial |
$62.71
|
| Rate for Payer: Cigna of CA HMO |
$54.87
|
| Rate for Payer: Cigna of CA PPO |
$54.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.36
|
| Rate for Payer: Galaxy Health WC |
$66.63
|
| Rate for Payer: Global Benefits Group Commercial |
$47.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.79
|
| Rate for Payer: IEHP medi-cal |
$27.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.14
|
| Rate for Payer: Multiplan Commercial |
$58.79
|
| Rate for Payer: Networks By Design Commercial |
$39.20
|
| Rate for Payer: Prime Health Services Commercial |
$66.63
|
| Rate for Payer: Riverside University Health MISP |
$31.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.20
|
| Rate for Payer: United Healthcare All Other HMO |
$39.20
|
| Rate for Payer: United Healthcare HMO Rider |
$39.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.63
|
| Rate for Payer: Vantage Medical Group Senior |
$66.63
|
|
|
HC BRACE WRIST UNIVERSAL RT WRAP
|
Facility
IP
|
$78.39
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901607656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Central Health Plan Commercial |
$62.71
|
| Rate for Payer: Cigna of CA HMO |
$54.87
|
| Rate for Payer: Cigna of CA PPO |
$54.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.36
|
| Rate for Payer: Galaxy Health WC |
$66.63
|
| Rate for Payer: Global Benefits Group Commercial |
$47.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$58.79
|
| Rate for Payer: Networks By Design Commercial |
$39.20
|
| Rate for Payer: Prime Health Services Commercial |
$66.63
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
OP
|
$5,195.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$4,675.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,139.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.88
|
| Rate for Payer: BCBS Transplant Transplant |
$3,117.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,210.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,524.77
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,156.00
|
| Rate for Payer: Cigna of CA HMO |
$3,324.80
|
| Rate for Payer: Cigna of CA PPO |
$3,844.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$4,415.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,675.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,896.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,465.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,896.25
|
| Rate for Payer: Networks By Design Commercial |
$3,376.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,415.75
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,117.00
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
IP
|
$5,195.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,039.00 |
| Max. Negotiated Rate |
$4,675.50 |
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,078.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,078.00
|
| Rate for Payer: Galaxy Health WC |
$4,415.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,675.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,465.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,896.25
|
| Rate for Payer: Networks By Design Commercial |
$3,376.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,415.75
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
OP
|
$5,195.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$4,675.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,139.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.88
|
| Rate for Payer: BCBS Transplant Transplant |
$3,117.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,210.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,524.77
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,156.00
|
| Rate for Payer: Cigna of CA HMO |
$3,324.80
|
| Rate for Payer: Cigna of CA PPO |
$3,844.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$4,415.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,675.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,896.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,465.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,896.25
|
| Rate for Payer: Networks By Design Commercial |
$3,376.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,415.75
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,117.00
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
IP
|
$5,195.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,039.00 |
| Max. Negotiated Rate |
$4,675.50 |
| Rate for Payer: Cash Price |
$2,337.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,078.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,078.00
|
| Rate for Payer: Galaxy Health WC |
$4,415.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,675.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,465.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,896.25
|
| Rate for Payer: Networks By Design Commercial |
$3,376.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,415.75
|
|
