|
HC SPLINT COCK-UP FOAM PAD SM
|
Facility
|
OP
|
$50.43
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$42.87 |
| Rate for Payer: Adventist Health Commercial |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.53
|
| Rate for Payer: Blue Shield of California Commercial |
$25.57
|
| Rate for Payer: Blue Shield of California Commercial |
$38.78
|
| Rate for Payer: Cash Price |
$22.69
|
| Rate for Payer: Cigna of CA HMO |
$35.30
|
| Rate for Payer: Cigna of CA PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.87
|
| Rate for Payer: 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 Medi-Cal |
$18.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$40.34
|
| Rate for Payer: Networks By Design Commercial |
$25.21
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.93
|
| Rate for Payer: United Healthcare All Other HMO |
$18.42
|
| Rate for Payer: United Healthcare HMO Rider |
$18.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.87
|
| Rate for Payer: Vantage Medical Group Senior |
$42.87
|
|
|
HC SPLINT COLLES LG RT
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$22.87
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
|
|
HC SPLINT COLLES LG RT
|
Facility
|
OP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.29
|
| Rate for Payer: Blue Shield of California Commercial |
$27.05
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.63
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.90
|
| Rate for Payer: Vantage Medical Group Senior |
$29.90
|
|
|
HC SPLINT COLLES MED LT
|
Facility
|
OP
|
$36.65
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$15.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.18
|
| Rate for Payer: Blue Shield of California Commercial |
$28.18
|
| Rate for Payer: Blue Shield of California Commercial |
$18.58
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cigna of CA HMO |
$25.66
|
| Rate for Payer: Cigna of CA PPO |
$25.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.66
|
| Rate for Payer: EPIC Health Plan Senior |
$14.66
|
| Rate for Payer: Galaxy Health WC |
$31.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.66
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
| Rate for Payer: Networks By Design Commercial |
$18.32
|
| Rate for Payer: Prime Health Services Commercial |
$31.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.15
|
| Rate for Payer: Vantage Medical Group Senior |
$31.15
|
|
|
HC SPLINT COLLES MED LT
|
Facility
|
IP
|
$36.65
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cigna of CA HMO |
$25.66
|
| Rate for Payer: Cigna of CA PPO |
$25.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.66
|
| Rate for Payer: EPIC Health Plan Senior |
$14.66
|
| Rate for Payer: Galaxy Health WC |
$31.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
| Rate for Payer: Networks By Design Commercial |
$23.82
|
| Rate for Payer: Prime Health Services Commercial |
$31.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
IP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$22.87
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
OP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.29
|
| Rate for Payer: Blue Shield of California Commercial |
$27.05
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$24.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.63
|
| Rate for Payer: Multiplan Commercial |
$28.14
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.85
|
| Rate for Payer: United Healthcare HMO Rider |
$12.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.90
|
| Rate for Payer: Vantage Medical Group Senior |
$29.90
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$6.89
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$6.67
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.31
|
| Rate for Payer: Multiplan Commercial |
$7.22
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.67 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.22
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
|
|
HC SPLINT FINGER LG CURVED 6"
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| 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 |
$3.26
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.00
|
| 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 LG CURVED 6"
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606410
|
|
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: Cash Price |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| 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
|
|
|
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 |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| 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 |
$3.26
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.00
|
| 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 MEDIUM CURVED 3"
|
Facility
|
IP
|
$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: Cash Price |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| 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
|
|
|
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 |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.29
|
| 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 |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| 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 |
$3.58
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$2.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.29
|
| 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
|
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 |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| 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 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 |
$37.26 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| 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 |
$3.79
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| 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 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 |
$2.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$2.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| 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 |
$3.20
|
| 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
|
|
