|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
OP
|
$261.52
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.53 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.51
|
| Rate for Payer: Blue Distinction Transplant |
$156.91
|
| Rate for Payer: Blue Shield of California Commercial |
$196.14
|
| Rate for Payer: Blue Shield of California EPN |
$142.27
|
| Rate for Payer: Cash Price |
$117.68
|
| Rate for Payer: Central Health Plan Commercial |
$209.22
|
| Rate for Payer: Cigna of CA HMO |
$183.06
|
| Rate for Payer: Cigna of CA PPO |
$183.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.29
|
| Rate for Payer: Dignity Health Media |
$222.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.61
|
| Rate for Payer: Galaxy Health WC |
$222.29
|
| Rate for Payer: Global Benefits Group Commercial |
$156.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$196.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.22
|
| Rate for Payer: Multiplan Commercial |
$196.14
|
| Rate for Payer: Networks By Design Commercial |
$130.76
|
| Rate for Payer: Prime Health Services Commercial |
$222.29
|
| Rate for Payer: Riverside University Health System MISP |
$104.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.76
|
| Rate for Payer: United Healthcare All Other HMO |
$130.76
|
| Rate for Payer: United Healthcare HMO Rider |
$130.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.29
|
| Rate for Payer: Vantage Medical Group Senior |
$222.29
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
IP
|
$261.52
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$117.68
|
| Rate for Payer: Central Health Plan Commercial |
$209.22
|
| Rate for Payer: Cigna of CA HMO |
$183.06
|
| Rate for Payer: Cigna of CA PPO |
$183.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.61
|
| Rate for Payer: Galaxy Health WC |
$222.29
|
| Rate for Payer: Global Benefits Group Commercial |
$156.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.30
|
| Rate for Payer: Multiplan Commercial |
$196.14
|
| Rate for Payer: Networks By Design Commercial |
$130.76
|
| Rate for Payer: Prime Health Services Commercial |
$222.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.75
|
| Rate for Payer: United Healthcare All Other HMO |
$96.45
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.30
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
IP
|
$242.48
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Blue Shield of California EPN |
$129.48
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.56
|
| Rate for Payer: United Healthcare All Other HMO |
$89.43
|
| Rate for Payer: United Healthcare HMO Rider |
$87.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.02
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
OP
|
$242.48
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.26
|
| Rate for Payer: Blue Distinction Transplant |
$145.49
|
| Rate for Payer: Blue Shield of California Commercial |
$181.86
|
| Rate for Payer: Blue Shield of California EPN |
$131.91
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.11
|
| Rate for Payer: Dignity Health Media |
$206.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.42
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: Riverside University Health System MISP |
$96.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.24
|
| Rate for Payer: United Healthcare All Other HMO |
$121.24
|
| Rate for Payer: United Healthcare HMO Rider |
$121.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.11
|
| Rate for Payer: Vantage Medical Group Senior |
$206.11
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
OP
|
$242.48
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.26
|
| Rate for Payer: Blue Distinction Transplant |
$145.49
|
| Rate for Payer: Blue Shield of California Commercial |
$181.86
|
| Rate for Payer: Blue Shield of California EPN |
$131.91
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.11
|
| Rate for Payer: Dignity Health Media |
$206.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.42
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: Riverside University Health System MISP |
$96.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.24
|
| Rate for Payer: United Healthcare All Other HMO |
$121.24
|
| Rate for Payer: United Healthcare HMO Rider |
$121.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.11
|
| Rate for Payer: Vantage Medical Group Senior |
$206.11
|
|
|
HC IMMOBILIZER, LEG PEDS 9" PAIR
|
Facility
|
IP
|
$242.48
|
|
| Hospital Charge Code |
901698337
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Blue Shield of California EPN |
$129.48
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.56
|
| Rate for Payer: United Healthcare All Other HMO |
$89.43
|
| Rate for Payer: United Healthcare HMO Rider |
$87.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.02
|
|
|
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: 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: 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: 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 |
$13.19 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| 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 |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| 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: 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
|
| 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 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 |
$134.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134.56
|
| 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 |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.34
|
| Rate for Payer: Blue Distinction Transplant |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$52.53
|
| Rate for Payer: Blue Shield of California EPN |
$40.84
|
| Rate for Payer: Cash Price |
$37.58
|
| 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 Media |
$70.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$62.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.23
|
| 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: 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
|
| 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 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: 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: 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: 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: Blue Shield of California EPN |
$107.43
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$40.24
|
| 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: United Healthcare All Other Commercial |
$75.97
|
| Rate for Payer: United Healthcare All Other HMO |
$74.20
|
| Rate for Payer: United Healthcare HMO Rider |
$72.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.39
|
|
|
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 |
$68.36 |
| Max. Negotiated Rate |
$181.06 |
| 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 |
$110.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.86
|
| Rate for Payer: Blue Distinction Transplant |
$120.71
|
| Rate for Payer: Blue Shield of California Commercial |
$150.88
|
| Rate for Payer: Blue Shield of California EPN |
$109.44
|
| 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 Media |
$171.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$150.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.41
|
| 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: LLUH Dept of Risk Management WC |
$82.48
|
| 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 |
$100.59
|
| Rate for Payer: United Healthcare All Other HMO |
$100.59
|
| Rate for Payer: United Healthcare HMO Rider |
$100.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.00
|
| Rate for Payer: Vantage Medical Group Senior |
$171.00
|
|
|
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: Blue Shield of California EPN |
$31.61
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$11.84
|
| 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: United Healthcare All Other Commercial |
$22.35
|
| Rate for Payer: United Healthcare All Other HMO |
$21.83
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
|
|
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 |
$20.72 |
| Max. Negotiated Rate |
$68.36 |
| 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 |
$32.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.98
|
| Rate for Payer: Blue Distinction Transplant |
$35.52
|
| Rate for Payer: Blue Shield of California Commercial |
$44.40
|
| Rate for Payer: Blue Shield of California EPN |
$32.20
|
| 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 Media |
$50.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$44.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.72
|
| 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: LLUH Dept of Risk Management WC |
$24.27
|
| 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 |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO |
$29.60
|
| Rate for Payer: United Healthcare HMO Rider |
$29.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.60
|
| 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
|
IP
|
$63.14
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$56.83 |
| Rate for Payer: Blue Shield of California EPN |
$33.72
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Central Health Plan Commercial |
$50.51
|
| Rate for Payer: Cigna of CA HMO |
$44.20
|
| Rate for Payer: Cigna of CA PPO |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.63
|
| Rate for Payer: Multiplan Commercial |
$47.36
|
| Rate for Payer: Networks By Design Commercial |
$31.57
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.84
|
| Rate for Payer: United Healthcare All Other HMO |
$23.29
|
| Rate for Payer: United Healthcare HMO Rider |
$22.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.84
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.30
|
| Rate for Payer: Blue Distinction Transplant |
$37.88
|
| Rate for Payer: Blue Shield of California Commercial |
$47.36
|
| Rate for Payer: Blue Shield of California EPN |
$34.35
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Central Health Plan Commercial |
$50.51
|
| Rate for Payer: Cigna of CA HMO |
$44.20
|
| Rate for Payer: Cigna of CA PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.67
|
| Rate for Payer: Dignity Health Media |
$53.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$47.36
|
| Rate for Payer: Networks By Design Commercial |
$31.57
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
| Rate for Payer: Riverside University Health System MISP |
$25.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.57
|
| Rate for Payer: United Healthcare All Other HMO |
$31.57
|
| Rate for Payer: United Healthcare HMO Rider |
$31.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Vantage Medical Group Senior |
$53.67
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.51
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.73
|
| Rate for Payer: United Healthcare All Other HMO |
$21.23
|
| Rate for Payer: United Healthcare HMO Rider |
$20.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.99
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.01
|
| Rate for Payer: Blue Distinction Transplant |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$43.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.31
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.93
|
| Rate for Payer: Dignity Health Media |
$48.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Riverside University Health System MISP |
$23.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.78
|
| Rate for Payer: United Healthcare All Other HMO |
$28.78
|
| Rate for Payer: United Healthcare HMO Rider |
$28.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.93
|
| Rate for Payer: Vantage Medical Group Senior |
$48.93
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$522.00 |
| 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 |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| 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 Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| 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: LLUH Dept of Risk Management WC |
$237.80
|
| 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 |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| 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: Blue Shield of California EPN |
$309.72
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$116.00
|
| 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: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: Blue Distinction Transplant |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$99.50
|
| Rate for Payer: Blue Shield of California EPN |
$78.25
|
| Rate for Payer: Caremore Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: Cigna of CA HMO |
$103.04
|
| Rate for Payer: Cigna of CA PPO |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Media |
$14.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$120.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: InnovAge PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Central Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.80
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.40
|
| Rate for Payer: Multiplan Commercial |
$177.75
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$434.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.97
|
| Rate for Payer: Blue Distinction Transplant |
$117.60
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Caremore Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.54
|
| Rate for Payer: Dignity Health Media |
$49.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.03
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$147.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.03
|
| Rate for Payer: InnovAge PACE Commercial |
$73.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$51.97
|
| Rate for Payer: Riverside University Health System MISP |
$53.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.72
|
| Rate for Payer: United Healthcare All Other HMO |
$39.72
|
| Rate for Payer: United Healthcare HMO Rider |
$39.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$184.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.54
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$44.50
|
| Rate for Payer: Blue Shield of California EPN |
$34.99
|
| Rate for Payer: Caremore Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Media |
$20.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
