|
HC SPINE MINIMUM 4 VIEWS
|
Facility
|
IP
|
$1,237.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$1,051.45 |
| Rate for Payer: Adventist Health Commercial |
$247.40
|
| Rate for Payer: Cash Price |
$680.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.80
|
| Rate for Payer: EPIC Health Plan Senior |
$494.80
|
| Rate for Payer: Galaxy Health WC |
$1,051.45
|
| Rate for Payer: Global Benefits Group Commercial |
$742.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.88
|
| Rate for Payer: Multiplan Commercial |
$989.60
|
| Rate for Payer: Networks By Design Commercial |
$804.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.45
|
|
|
HC SPINE SCAN
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,547.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,449.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.32
|
| Rate for Payer: Blue Shield of California EPN |
$953.44
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SPINE SCAN
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$899.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,460.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC SPINE SINGLE VIEW
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.09
|
| Rate for Payer: Blue Shield of California Commercial |
$428.40
|
| Rate for Payer: Blue Shield of California EPN |
$282.80
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna of CA HMO |
$448.00
|
| Rate for Payer: Cigna of CA PPO |
$518.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SPINE SINGLE VIEW
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
|
|
HC SPIROMETRY PHYSICIAN REV & INT
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
908600225
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC SPIROMETRY PHYSICIAN REV & INT
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
908600225
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.95
|
| Rate for Payer: Blue Shield of California Commercial |
$58.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.78
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
HC SPIROMETRY STUDIES
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC SPIROMETRY STUDIES
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.03
|
| Rate for Payer: Blue Shield of California Commercial |
$279.07
|
| Rate for Payer: Blue Shield of California EPN |
$184.22
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC SPLINT AIR FOOT/ANKLE
|
Facility
|
OP
|
$58.22
|
|
| Hospital Charge Code |
901698231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$49.49 |
| Rate for Payer: Adventist Health Commercial |
$11.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.75
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Cigna of CA HMO |
$37.26
|
| Rate for Payer: Cigna of CA PPO |
$43.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Senior |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$46.58
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29.11
|
| Rate for Payer: United Healthcare HMO Rider |
$29.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.49
|
| Rate for Payer: Vantage Medical Group Senior |
$49.49
|
|
|
HC SPLINT AIR FOOT/ANKLE
|
Facility
|
IP
|
$58.22
|
|
| Hospital Charge Code |
901698231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$49.49 |
| Rate for Payer: Adventist Health Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Senior |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Multiplan Commercial |
$46.58
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
|
|
HC SPLINT AIR HALF ARM
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.24
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC SPLINT AIR HALF ARM
|
Facility
|
IP
|
$54.12
|
|
| Hospital Charge Code |
901698230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.99
|
| Rate for Payer: Multiplan Commercial |
$43.30
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC SPLINT AIR HALF LEG
|
Facility
|
OP
|
$68.06
|
|
| Hospital Charge Code |
901698232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Adventist Health Commercial |
$13.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.80
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cigna of CA HMO |
$43.56
|
| Rate for Payer: Cigna of CA PPO |
$50.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Senior |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.64
|
| Rate for Payer: Multiplan Commercial |
$54.45
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.03
|
| Rate for Payer: United Healthcare All Other HMO |
$34.03
|
| Rate for Payer: United Healthcare HMO Rider |
$34.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.85
|
| Rate for Payer: Vantage Medical Group Senior |
$57.85
|
|
|
HC SPLINT AIR HALF LEG
|
Facility
|
IP
|
$68.06
|
|
| Hospital Charge Code |
901698232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Adventist Health Commercial |
$13.61
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Senior |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.33
|
| Rate for Payer: Multiplan Commercial |
$54.45
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
|
|
HC SPLINT AIR HAND/WRIST
|
Facility
|
IP
|
$46.74
|
|
| Hospital Charge Code |
901698229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$9.35
|
| Rate for Payer: Cash Price |
$25.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.70
|
| Rate for Payer: EPIC Health Plan Senior |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$39.73
|
| Rate for Payer: Global Benefits Group Commercial |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.22
|
| Rate for Payer: Multiplan Commercial |
$37.39
|
| Rate for Payer: Networks By Design Commercial |
$30.38
|
| Rate for Payer: Prime Health Services Commercial |
$39.73
|
|
|
HC SPLINT AIR HAND/WRIST
|
Facility
|
OP
|
$46.74
|
|
| Hospital Charge Code |
901698229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$9.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.70
|
| Rate for Payer: Cash Price |
$25.71
|
| Rate for Payer: Cigna of CA HMO |
$29.91
|
| Rate for Payer: Cigna of CA PPO |
$34.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.70
|
| Rate for Payer: EPIC Health Plan Senior |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$39.73
|
| Rate for Payer: Global Benefits Group Commercial |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.72
|
| Rate for Payer: Multiplan Commercial |
$37.39
|
| Rate for Payer: Networks By Design Commercial |
$30.38
|
| Rate for Payer: Prime Health Services Commercial |
$39.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.37
|
| Rate for Payer: United Healthcare All Other HMO |
$23.37
|
| Rate for Payer: United Healthcare HMO Rider |
$23.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.73
|
| Rate for Payer: Vantage Medical Group Senior |
$39.73
|
|
|
HC SPLINT AIR LARGE LEG
|
Facility
|
IP
|
$77.90
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
901698233
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna of CA HMO |
$54.53
|
| Rate for Payer: Cigna of CA PPO |
$54.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$62.32
|
| Rate for Payer: Networks By Design Commercial |
$38.95
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.24
|
| Rate for Payer: United Healthcare All Other HMO |
$28.46
|
| Rate for Payer: United Healthcare HMO Rider |
$27.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.51
|
|
|
HC SPLINT AIR LARGE LEG
|
Facility
|
OP
|
$77.90
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
901698233
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$31.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.12
|
| Rate for Payer: Blue Shield of California Commercial |
$57.49
|
| Rate for Payer: Blue Shield of California EPN |
$37.86
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna of CA HMO |
$54.53
|
| Rate for Payer: Cigna of CA PPO |
$54.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$178.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.53
|
| Rate for Payer: Multiplan Commercial |
$62.32
|
| Rate for Payer: Networks By Design Commercial |
$38.95
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.24
|
| Rate for Payer: United Healthcare All Other HMO |
$28.46
|
| Rate for Payer: United Healthcare HMO Rider |
$27.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.22
|
| Rate for Payer: Vantage Medical Group Senior |
$66.22
|
|
|
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 |
$4.06
|
| 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 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 |
$4.06
|
| 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 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 |
$50.62
|
| Rate for Payer: Cash Price |
$50.62
|
| 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 |
$50.62
|
| Rate for Payer: Cash Price |
$50.62
|
| 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 |
$22.91
|
| 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 |
$22.91
|
| Rate for Payer: Cash Price |
$22.91
|
| 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
|
|
