|
HC SPLINT FINGER MEDIUM CURVED 3"
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.12
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Senior |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC SPLINT FINGER OPEN PADDED 2.5"
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606411
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC SPLINT FINGER OPEN PADDED 2.5"
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606411
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.43
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC SPLINT FINGER SM. CURVED 1.5"
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC SPLINT FINGER SM. CURVED 1.5"
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.61
|
|
|
HC SPLINT FROG LARGE
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606407
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC SPLINT FROG LARGE
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606407
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SPLINT FROG MEDIUM
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606406
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC SPLINT FROG MEDIUM
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606406
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SPLINT FROG SMALL
|
Facility
|
IP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606405
|
|
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 FROG SMALL
|
Facility
|
OP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606405
|
|
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 PLASTER 3X15 50/BX
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
HC SPLINT PLASTER 3X15 50/BX
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.85
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1.18
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.71
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$2.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
|
|
HC SPLINT SLING ARM MED
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cigna of CA HMO |
$14.74
|
| Rate for Payer: Cigna of CA PPO |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
|
|
HC SPLINT SLING ARM MED
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$17.90 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15.54
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cigna of CA HMO |
$14.74
|
| Rate for Payer: Cigna of CA PPO |
$14.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.74
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
915352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.65
|
| Rate for Payer: Blue Shield of California Commercial |
$360.14
|
| Rate for Payer: Blue Shield of California EPN |
$237.17
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
915352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
905352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.65
|
| Rate for Payer: Blue Shield of California Commercial |
$360.14
|
| Rate for Payer: Blue Shield of California EPN |
$237.17
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
905352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
