|
HC SPLINT ALUMAFOAM 18" X .5"
|
Facility
|
OP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC SPLINT ALUMAFOAM 18" X .5"
|
Facility
|
IP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
HC SPLINT ANKLE STIRRUP AIR/FOAM
|
Facility
|
OP
|
$92.04
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698313
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.09 |
| Max. Negotiated Rate |
$136.38 |
| Rate for Payer: Adventist Health Commercial |
$37.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.31
|
| Rate for Payer: Blue Shield of California Commercial |
$67.93
|
| Rate for Payer: Blue Shield of California EPN |
$44.73
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cigna of CA HMO |
$64.43
|
| Rate for Payer: Cigna of CA PPO |
$64.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.23
|
| Rate for Payer: Global Benefits Group Commercial |
$55.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.43
|
| Rate for Payer: Multiplan Commercial |
$73.63
|
| Rate for Payer: Networks By Design Commercial |
$46.02
|
| Rate for Payer: Prime Health Services Commercial |
$78.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.54
|
| Rate for Payer: United Healthcare All Other HMO |
$33.62
|
| Rate for Payer: United Healthcare HMO Rider |
$32.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.23
|
| Rate for Payer: Vantage Medical Group Senior |
$78.23
|
|
|
HC SPLINT ANKLE STIRRUP AIR/FOAM
|
Facility
|
IP
|
$92.04
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698313
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cigna of CA HMO |
$64.43
|
| Rate for Payer: Cigna of CA PPO |
$64.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.23
|
| Rate for Payer: Global Benefits Group Commercial |
$55.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.09
|
| Rate for Payer: Multiplan Commercial |
$73.63
|
| Rate for Payer: Networks By Design Commercial |
$46.02
|
| Rate for Payer: Prime Health Services Commercial |
$78.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.54
|
| Rate for Payer: United Healthcare All Other HMO |
$33.62
|
| Rate for Payer: United Healthcare HMO Rider |
$32.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.14
|
|
|
HC SPLINT COCK-UP FOAM PAD LG
|
Facility
|
OP
|
$41.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$17.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.13
|
| Rate for Payer: Blue Shield of California Commercial |
$30.75
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$29.16
|
| Rate for Payer: Cigna of CA PPO |
$29.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.16
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$20.83
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.22
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.41
|
| Rate for Payer: Vantage Medical Group Senior |
$35.41
|
|
|
HC SPLINT COCK-UP FOAM PAD LG
|
Facility
|
IP
|
$41.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$29.16
|
| Rate for Payer: Cigna of CA PPO |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$20.83
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.63
|
| Rate for Payer: United Healthcare All Other HMO |
$15.22
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.64
|
|
|
HC SPLINT COCK-UP FOAM PAD SM
|
Facility
|
OP
|
$50.43
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Adventist Health Commercial |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.21
|
| Rate for Payer: Blue Shield of California Commercial |
$37.22
|
| Rate for Payer: Blue Shield of California EPN |
$24.51
|
| Rate for Payer: Cash Price |
$22.69
|
| Rate for Payer: Cigna of CA HMO |
$35.30
|
| Rate for Payer: Cigna of CA PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.17
|
| Rate for Payer: EPIC Health Plan Senior |
$20.17
|
| Rate for Payer: Galaxy Health WC |
$42.87
|
| Rate for Payer: Global Benefits Group Commercial |
$30.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$40.34
|
| Rate for Payer: Networks By Design Commercial |
$25.21
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.93
|
| Rate for Payer: United Healthcare All Other HMO |
$18.42
|
| Rate for Payer: United Healthcare HMO Rider |
$18.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.87
|
| Rate for Payer: Vantage Medical Group Senior |
$42.87
|
|
|
HC SPLINT COCK-UP FOAM PAD SM
|
Facility
|
IP
|
$50.43
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.69
|
| Rate for Payer: Cash Price |
$22.69
|
| Rate for Payer: Cigna of CA HMO |
$35.30
|
| Rate for Payer: Cigna of CA PPO |
$35.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.17
|
| Rate for Payer: EPIC Health Plan Senior |
$20.17
|
| Rate for Payer: Galaxy Health WC |
$42.87
|
| Rate for Payer: Global Benefits Group Commercial |
$30.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Multiplan Commercial |
$40.34
|
| Rate for Payer: Networks By Design Commercial |
$25.21
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.93
|
| Rate for Payer: United Healthcare All Other HMO |
$18.42
|
| Rate for Payer: United Healthcare HMO Rider |
$18.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
|
|
HC SPLINT COLLES LG LT
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698121
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cigna of CA HMO |
$21.87
|
| Rate for Payer: Cigna of CA PPO |
$21.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$24.99
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.23
|
|
|
HC SPLINT COLLES LG LT
|
Facility
|
OP
|
$31.24
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698121
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$12.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.09
|
| Rate for Payer: Blue Shield of California Commercial |
$23.06
|
| Rate for Payer: Blue Shield of California EPN |
$15.18
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cigna of CA HMO |
$21.87
|
| Rate for Payer: Cigna of CA PPO |
$21.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$24.99
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.55
|
| Rate for Payer: Vantage Medical Group Senior |
$26.55
|
|
|
HC SPLINT COLLES LG RT
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
|
|
HC SPLINT COLLES LG RT
|
Facility
|
OP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.38
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.10
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.63
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.90
|
| Rate for Payer: Vantage Medical Group Senior |
$29.90
|
|
|
HC SPLINT COLLES MED LT
|
Facility
|
OP
|
$36.65
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$15.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.23
|
| Rate for Payer: Blue Shield of California Commercial |
$27.05
|
| Rate for Payer: Blue Shield of California EPN |
$17.81
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cigna of CA HMO |
$25.66
|
| Rate for Payer: Cigna of CA PPO |
$25.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.66
|
| Rate for Payer: EPIC Health Plan Senior |
$14.66
|
| Rate for Payer: Galaxy Health WC |
$31.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.66
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
| Rate for Payer: Networks By Design Commercial |
$18.32
|
| Rate for Payer: Prime Health Services Commercial |
$31.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.15
|
| Rate for Payer: Vantage Medical Group Senior |
$31.15
|
|
|
HC SPLINT COLLES MED LT
|
Facility
|
IP
|
$36.65
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cigna of CA HMO |
$25.66
|
| Rate for Payer: Cigna of CA PPO |
$25.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.66
|
| Rate for Payer: EPIC Health Plan Senior |
$14.66
|
| Rate for Payer: Galaxy Health WC |
$31.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
| Rate for Payer: Networks By Design Commercial |
$18.32
|
| Rate for Payer: Prime Health Services Commercial |
$31.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
OP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.38
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.10
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.63
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.90
|
| Rate for Payer: Vantage Medical Group Senior |
$29.90
|
|
|
HC SPLINT COLLES SM LT
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698118
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.24
|
| Rate for Payer: Blue Shield of California Commercial |
$21.97
|
| Rate for Payer: Blue Shield of California EPN |
$14.47
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SPLINT COLLES SM LT
|
Facility
|
IP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698118
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
|
|
HC SPLINT COLLES SM RT
|
Facility
|
IP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698119
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
|
|
HC SPLINT COLLES SM RT
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698119
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.24
|
| Rate for Payer: Blue Shield of California Commercial |
$21.97
|
| Rate for Payer: Blue Shield of California EPN |
$14.47
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
