|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
IP
|
$273.21
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$54.64
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$177.59
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
OP
|
$273.21
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$112.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.46
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: InnovAge PACE Commercial |
$136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$136.60
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: Riverside University Health System MISP |
$109.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Vantage Medical Group Senior |
$232.23
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
IP
|
$294.63
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$148.49
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Central Health Plan Commercial |
$235.70
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.93
|
| Rate for Payer: Multiplan Commercial |
$220.97
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.57
|
| Rate for Payer: United Healthcare All Other HMO |
$107.63
|
| Rate for Payer: United Healthcare HMO Rider |
$105.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.49
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
OP
|
$294.63
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.04
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$148.49
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Central Health Plan Commercial |
$235.70
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.17
|
| Rate for Payer: InnovAge PACE Commercial |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.24
|
| Rate for Payer: Multiplan Commercial |
$220.97
|
| Rate for Payer: Networks By Design Commercial |
$147.31
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: Riverside University Health System MISP |
$117.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.57
|
| Rate for Payer: United Healthcare All Other HMO |
$107.63
|
| Rate for Payer: United Healthcare HMO Rider |
$105.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.44
|
| Rate for Payer: Vantage Medical Group Senior |
$250.44
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
IP
|
$273.21
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$54.64
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$177.59
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
OP
|
$273.21
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$112.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.46
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: InnovAge PACE Commercial |
$136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$136.60
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: Riverside University Health System MISP |
$109.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Vantage Medical Group Senior |
$232.23
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
OP
|
$273.21
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$112.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.46
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: InnovAge PACE Commercial |
$136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$136.60
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: Riverside University Health System MISP |
$109.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Vantage Medical Group Senior |
$232.23
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
IP
|
$273.21
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$54.64
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$122.94
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$177.59
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
|
|
HC IMMOBILIZER SHLDR ELASTIC MED
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC IMMOBILIZER SHLDR ELASTIC MED
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
OP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$51.03
|
| Rate for Payer: Blue Shield of California EPN |
$33.32
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$66.82
|
| Rate for Payer: Cigna of CA HMO |
$53.45
|
| Rate for Payer: Cigna of CA PPO |
$61.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.17
|
| Rate for Payer: InnovAge PACE Commercial |
$41.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$62.64
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
| Rate for Payer: Riverside University Health System MISP |
$33.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.76
|
| Rate for Payer: United Healthcare All Other HMO |
$41.76
|
| Rate for Payer: United Healthcare HMO Rider |
$41.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.99
|
| Rate for Payer: Vantage Medical Group Senior |
$70.99
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
IP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$66.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$62.64
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
IP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$181.06 |
| Rate for Payer: Adventist Health Commercial |
$40.24
|
| Rate for Payer: Blue Shield of California Commercial |
$155.51
|
| Rate for Payer: Blue Shield of California EPN |
$101.39
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Central Health Plan Commercial |
$160.94
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.24
|
| Rate for Payer: Multiplan Commercial |
$150.88
|
| Rate for Payer: Networks By Design Commercial |
$130.77
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
OP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$181.06 |
| Rate for Payer: Adventist Health Commercial |
$82.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.15
|
| Rate for Payer: Blue Shield of California Commercial |
$155.51
|
| Rate for Payer: Blue Shield of California EPN |
$101.39
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Central Health Plan Commercial |
$160.94
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$100.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.83
|
| Rate for Payer: Multiplan Commercial |
$150.88
|
| Rate for Payer: Networks By Design Commercial |
$100.59
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: Riverside University Health System MISP |
$80.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.00
|
| Rate for Payer: Vantage Medical Group Senior |
$171.00
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.86
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
|
|
HC IMMOBILIZER SHLDR MED W/STRAPS
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Adventist Health Commercial |
$11.84
|
| Rate for Payer: Blue Shield of California Commercial |
$45.76
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.36
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Senior |
$23.68
|
| Rate for Payer: Galaxy Health WC |
$50.32
|
| Rate for Payer: Global Benefits Group Commercial |
$35.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.84
|
| Rate for Payer: Multiplan Commercial |
$44.40
|
| Rate for Payer: Networks By Design Commercial |
$38.48
|
| Rate for Payer: Prime Health Services Commercial |
$50.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$21.63
|
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.39
|
|
|
HC IMMOBILIZER SHLDR MED W/STRAPS
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.77
|
| Rate for Payer: Blue Shield of California Commercial |
$45.76
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.36
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Senior |
$23.68
|
| Rate for Payer: Galaxy Health WC |
$50.32
|
| Rate for Payer: Global Benefits Group Commercial |
$35.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.44
|
| Rate for Payer: Multiplan Commercial |
$44.40
|
| Rate for Payer: Networks By Design Commercial |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$50.32
|
| Rate for Payer: Riverside University Health System MISP |
$23.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$21.63
|
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.32
|
| Rate for Payer: Vantage Medical Group Senior |
$50.32
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
OP
|
$70.77
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Adventist Health Commercial |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.56
|
| Rate for Payer: Blue Shield of California Commercial |
$54.71
|
| Rate for Payer: Blue Shield of California EPN |
$35.67
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Central Health Plan Commercial |
$56.62
|
| Rate for Payer: Cigna of CA HMO |
$49.54
|
| Rate for Payer: Cigna of CA PPO |
$49.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.31
|
| Rate for Payer: EPIC Health Plan Senior |
$28.31
|
| Rate for Payer: Galaxy Health WC |
$60.15
|
| Rate for Payer: Global Benefits Group Commercial |
$42.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,306.89
|
| Rate for Payer: InnovAge PACE Commercial |
$35.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$53.08
|
| Rate for Payer: Networks By Design Commercial |
$35.38
|
| Rate for Payer: Prime Health Services Commercial |
$60.15
|
| Rate for Payer: Riverside University Health System MISP |
$28.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.56
|
| Rate for Payer: United Healthcare All Other HMO |
$25.85
|
| Rate for Payer: United Healthcare HMO Rider |
$25.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.15
|
| Rate for Payer: Vantage Medical Group Senior |
$60.15
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
IP
|
$70.77
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$63.69 |
| Rate for Payer: Adventist Health Commercial |
$14.15
|
| Rate for Payer: Blue Shield of California Commercial |
$54.71
|
| Rate for Payer: Blue Shield of California EPN |
$35.67
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Central Health Plan Commercial |
$56.62
|
| Rate for Payer: Cigna of CA HMO |
$49.54
|
| Rate for Payer: Cigna of CA PPO |
$49.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.31
|
| Rate for Payer: EPIC Health Plan Senior |
$28.31
|
| Rate for Payer: Galaxy Health WC |
$60.15
|
| Rate for Payer: Global Benefits Group Commercial |
$42.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$53.08
|
| Rate for Payer: Networks By Design Commercial |
$46.00
|
| Rate for Payer: Prime Health Services Commercial |
$60.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.56
|
| Rate for Payer: United Healthcare All Other HMO |
$25.85
|
| Rate for Payer: United Healthcare HMO Rider |
$25.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.18
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
OP
|
$60.11
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Adventist Health Commercial |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.30
|
| Rate for Payer: Blue Shield of California Commercial |
$46.47
|
| Rate for Payer: Blue Shield of California EPN |
$30.30
|
| Rate for Payer: Cash Price |
$27.05
|
| Rate for Payer: Cash Price |
$27.05
|
| Rate for Payer: Central Health Plan Commercial |
$48.09
|
| Rate for Payer: Cigna of CA HMO |
$42.08
|
| Rate for Payer: Cigna of CA PPO |
$42.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Senior |
$24.04
|
| Rate for Payer: Galaxy Health WC |
$51.09
|
| Rate for Payer: Global Benefits Group Commercial |
$36.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,306.89
|
| Rate for Payer: InnovAge PACE Commercial |
$30.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.08
|
| Rate for Payer: Multiplan Commercial |
$45.08
|
| Rate for Payer: Networks By Design Commercial |
$30.05
|
| Rate for Payer: Prime Health Services Commercial |
$51.09
|
| Rate for Payer: Riverside University Health System MISP |
$24.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.56
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.09
|
| Rate for Payer: Vantage Medical Group Senior |
$51.09
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
IP
|
$60.11
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California Commercial |
$46.47
|
| Rate for Payer: Blue Shield of California EPN |
$30.30
|
| Rate for Payer: Cash Price |
$27.05
|
| Rate for Payer: Central Health Plan Commercial |
$48.09
|
| Rate for Payer: Cigna of CA HMO |
$42.08
|
| Rate for Payer: Cigna of CA PPO |
$42.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Senior |
$24.04
|
| Rate for Payer: Galaxy Health WC |
$51.09
|
| Rate for Payer: Global Benefits Group Commercial |
$36.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.02
|
| Rate for Payer: Multiplan Commercial |
$45.08
|
| Rate for Payer: Networks By Design Commercial |
$39.07
|
| Rate for Payer: Prime Health Services Commercial |
$51.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.56
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.69
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.95 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
