|
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 |
$1,062.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,392.40
|
| 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 SCAN
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$567.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,514.41
|
| Rate for Payer: Blue Shield of California Commercial |
$993.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.68
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| 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/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$490.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$444.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.00
|
| 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 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 |
$116.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.50
|
| Rate for Payer: Blue Shield of California Commercial |
$294.70
|
| Rate for Payer: Blue Shield of California Commercial |
$446.60
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$490.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$444.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.18
|
| 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 |
$61.60
|
| Rate for Payer: Blue Shield of California Commercial |
$61.25
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| 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 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 |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| 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 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 |
$205.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| 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 |
$197.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.62
|
| Rate for Payer: Blue Shield of California Commercial |
$191.98
|
| Rate for Payer: Blue Shield of California Commercial |
$290.93
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$37.36
|
| Rate for Payer: Cash Price |
$26.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.75
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.35
|
| 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 |
$26.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.75
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.35
|
| 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
|
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 |
$24.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| 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 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 |
$34.73
|
| Rate for Payer: Cash Price |
$24.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| 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 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 |
$43.67
|
| Rate for Payer: Cash Price |
$30.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.64
|
| 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 Foundation Hospitals Commercial/Self Funded |
$43.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.16
|
| 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 |
$30.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.64
|
| 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 Foundation Hospitals Commercial/Self Funded |
$43.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.16
|
| 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
|
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 |
$29.99
|
| Rate for Payer: Cash Price |
$21.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$29.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.58
|
| 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 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 |
$21.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$29.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.58
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cigna of CA HMO |
$54.53
|
| Rate for Payer: Cigna of CA PPO |
$54.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$49.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.96
|
| 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 |
$50.63
|
| 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 |
$47.15
|
| Rate for Payer: Blue Shield of California Commercial |
$59.91
|
| Rate for Payer: Blue Shield of California Commercial |
$39.50
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$35.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$178.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.96
|
| 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 |
$3.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| 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 |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| 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 |
$4.74
|
| Rate for Payer: Cash Price |
$3.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| 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 |
$55.71
|
| Rate for Payer: Blue Shield of California Commercial |
$70.78
|
| Rate for Payer: Blue Shield of California Commercial |
$46.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.30
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$58.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.30
|
| 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 |
$59.83
|
| 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 |
$25.22
|
| Rate for Payer: Blue Shield of California Commercial |
$21.12
|
| Rate for Payer: Blue Shield of California Commercial |
$32.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$26.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.58
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$26.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.58
|
| 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 |
$27.08
|
| 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
|
IP
|
$50.43
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$14,109.00 |
| 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: Adventist Health Commercial |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$22.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.75
|
| 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 |
$32.78
|
| 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
|
|
