|
HC SPINE SINGLE VIEW
|
Facility
IP
|
$897.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC SPINE SINGLE VIEW
|
Facility
OP
|
$897.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.89
|
| Rate for Payer: BCBS Transplant Transplant |
$538.20
|
| Rate for Payer: Blue Shield of California Commercial |
$554.35
|
| Rate for Payer: Blue Shield of California EPN |
$435.94
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$672.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$538.20
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$538.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SPIROMETRY STUDIES
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC SPIROMETRY STUDIES
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.22
|
| Rate for Payer: BCBS Transplant Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$321.36
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$332.80
|
| Rate for Payer: Cigna of CA PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$390.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
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 |
$52.40 |
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Central Health Plan Commercial |
$46.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$43.66
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
|
|
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 |
$52.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: BCBS Transplant Transplant |
$34.93
|
| Rate for Payer: Blue Shield of California Commercial |
$36.62
|
| Rate for Payer: Blue Shield of California EPN |
$28.47
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Central Health Plan Commercial |
$46.58
|
| 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: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$43.66
|
| Rate for Payer: IEHP medi-cal |
$20.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$43.66
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$34.93
|
| Rate for Payer: Riverside University Health MISP |
$23.29
|
| 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 Medi-Cal |
$49.49
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$48.71 |
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| 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 |
$48.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.97
|
| Rate for Payer: BCBS Transplant Transplant |
$32.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.46
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| 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: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.59
|
| Rate for Payer: IEHP medi-cal |
$18.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: Riverside University Health MISP |
$21.65
|
| 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 Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
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 |
$61.25 |
| Rate for Payer: Cash Price |
$30.63
|
| Rate for Payer: Central Health Plan Commercial |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.61
|
| Rate for Payer: Multiplan Commercial |
$51.04
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
|
|
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 |
$61.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.21
|
| Rate for Payer: BCBS Transplant Transplant |
$40.84
|
| Rate for Payer: Blue Shield of California Commercial |
$42.81
|
| Rate for Payer: Blue Shield of California EPN |
$33.28
|
| Rate for Payer: Cash Price |
$30.63
|
| Rate for Payer: Central Health Plan Commercial |
$54.45
|
| 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: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$51.04
|
| Rate for Payer: IEHP medi-cal |
$23.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.61
|
| Rate for Payer: Multiplan Commercial |
$51.04
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$40.84
|
| Rate for Payer: Riverside University Health MISP |
$27.22
|
| 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 Medi-Cal |
$57.85
|
| Rate for Payer: Vantage Medical Group Senior |
$57.85
|
|
|
HC SPLINT AIR HAND/WRIST
|
Facility
IP
|
$46.74
|
|
| Hospital Charge Code |
901698229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$42.07 |
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Central Health Plan Commercial |
$37.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$39.73
|
| Rate for Payer: Global Benefits Group Commercial |
$28.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$35.06
|
| Rate for Payer: Networks By Design Commercial |
$30.38
|
| Rate for Payer: Prime Health Services Commercial |
$39.73
|
|
|
HC SPLINT AIR HAND/WRIST
|
Facility
OP
|
$46.74
|
|
| Hospital Charge Code |
901698229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$42.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: BCBS Transplant Transplant |
$28.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California EPN |
$22.86
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Central Health Plan Commercial |
$37.39
|
| 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: EPIC Health Plan Commercial |
$18.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$39.73
|
| Rate for Payer: Global Benefits Group Commercial |
$28.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.06
|
| Rate for Payer: IEHP medi-cal |
$16.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$35.06
|
| Rate for Payer: Networks By Design Commercial |
$30.38
|
| Rate for Payer: Prime Health Services Commercial |
$39.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.04
|
| Rate for Payer: Riverside University Health MISP |
$18.70
|
| 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 Medi-Cal |
$39.73
|
| Rate for Payer: Vantage Medical Group Senior |
$39.73
|
|
|
HC SPLINT AIR LARGE LEG
|
Facility
OP
|
$77.90
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
901698233
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$783.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$783.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.02
|
| Rate for Payer: BCBS Transplant Transplant |
$46.74
|
| Rate for Payer: Blue Shield of California Commercial |
$58.42
|
| Rate for Payer: Blue Shield of California EPN |
$42.38
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| 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: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.42
|
| Rate for Payer: IEHP medi-cal |
$27.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.94
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$38.95
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
| Rate for Payer: Riverside University Health MISP |
$31.16
|
| 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 |
$38.95
|
| Rate for Payer: United Healthcare All Other HMO |
$38.95
|
| Rate for Payer: United Healthcare HMO Rider |
$38.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.22
|
| Rate for Payer: Vantage Medical Group Senior |
$66.22
|
|
|
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 |
$70.11 |
| Rate for Payer: Blue Shield of California EPN |
$41.60
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| Rate for Payer: Cigna of CA HMO |
$54.53
|
| Rate for Payer: Cigna of CA PPO |
$54.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$38.95
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
|
|
HC SPLINT ALUMAFOAM 18" X .5"
|
Facility
IP
|
$43.30
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$38.97 |
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Central Health Plan Commercial |
$34.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
|
|
HC SPLINT ALUMAFOAM 18" X .5"
|
Facility
OP
|
$43.30
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$38.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: BCBS Transplant Transplant |
$25.98
|
| Rate for Payer: Blue Shield of California Commercial |
$27.24
|
| Rate for Payer: Blue Shield of California EPN |
$21.17
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Central Health Plan Commercial |
$34.64
|
| Rate for Payer: Cigna of CA HMO |
$27.71
|
| Rate for Payer: Cigna of CA PPO |
$32.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.48
|
| Rate for Payer: IEHP medi-cal |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: Riverside University Health MISP |
$17.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.65
|
| Rate for Payer: United Healthcare All Other HMO |
$21.65
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
|
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 |
$32.21 |
| Max. Negotiated Rate |
$371.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$78.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$50.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.38
|
| Rate for Payer: BCBS Transplant Transplant |
$55.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.03
|
| Rate for Payer: Blue Shield of California EPN |
$50.07
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Central Health Plan Commercial |
$73.63
|
| 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: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.23
|
| Rate for Payer: Global Benefits Group Commercial |
$55.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.03
|
| Rate for Payer: IEHP medi-cal |
$32.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.74
|
| Rate for Payer: Multiplan Commercial |
$69.03
|
| Rate for Payer: Networks By Design Commercial |
$46.02
|
| Rate for Payer: Prime Health Services Commercial |
$78.23
|
| Rate for Payer: Riverside University Health MISP |
$36.82
|
| 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 |
$46.02
|
| Rate for Payer: United Healthcare All Other HMO |
$46.02
|
| Rate for Payer: United Healthcare HMO Rider |
$46.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.02
|
| 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 |
$82.84 |
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Central Health Plan Commercial |
$73.63
|
| Rate for Payer: Cigna of CA HMO |
$64.43
|
| Rate for Payer: Cigna of CA PPO |
$64.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.23
|
| Rate for Payer: Global Benefits Group Commercial |
$55.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$69.03
|
| Rate for Payer: Networks By Design Commercial |
$46.02
|
| Rate for Payer: Prime Health Services Commercial |
$78.23
|
|
|
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 |
$37.49 |
| Rate for Payer: Blue Shield of California EPN |
$22.25
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Central Health Plan Commercial |
$33.33
|
| Rate for Payer: Cigna of CA HMO |
$29.16
|
| Rate for Payer: Cigna of CA PPO |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$31.24
|
| Rate for Payer: Networks By Design Commercial |
$20.83
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
|
|
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 |
$14.58 |
| Max. Negotiated Rate |
$37.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.61
|
| Rate for Payer: BCBS Transplant Transplant |
$25.00
|
| Rate for Payer: Blue Shield of California Commercial |
$31.24
|
| Rate for Payer: Blue Shield of California EPN |
$22.66
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Central Health Plan Commercial |
$33.33
|
| 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: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.24
|
| Rate for Payer: IEHP medi-cal |
$14.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$31.24
|
| Rate for Payer: Networks By Design Commercial |
$20.83
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: Riverside University Health MISP |
$16.66
|
| 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 |
$20.83
|
| Rate for Payer: United Healthcare All Other HMO |
$20.83
|
| Rate for Payer: United Healthcare HMO Rider |
$20.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.83
|
| 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 SM
|
Facility
OP
|
$46.41
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$41.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.42
|
| Rate for Payer: BCBS Transplant Transplant |
$27.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.81
|
| Rate for Payer: Blue Shield of California EPN |
$25.25
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Central Health Plan Commercial |
$37.13
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$32.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$39.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.81
|
| Rate for Payer: IEHP medi-cal |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$34.81
|
| Rate for Payer: Networks By Design Commercial |
$23.20
|
| Rate for Payer: Prime Health Services Commercial |
$39.45
|
| Rate for Payer: Riverside University Health MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.20
|
| Rate for Payer: United Healthcare All Other HMO |
$23.20
|
| Rate for Payer: United Healthcare HMO Rider |
$23.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.45
|
| Rate for Payer: Vantage Medical Group Senior |
$39.45
|
|
|
HC SPLINT COCK-UP FOAM PAD SM
|
Facility
IP
|
$46.41
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$41.77 |
| Rate for Payer: Blue Shield of California EPN |
$24.78
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Central Health Plan Commercial |
$37.13
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$32.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$39.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.28
|
| Rate for Payer: Multiplan Commercial |
$34.81
|
| Rate for Payer: Networks By Design Commercial |
$23.20
|
| Rate for Payer: Prime Health Services Commercial |
$39.45
|
|
|
HC SPLINT COLLES LG RT
|
Facility
IP
|
$34.11
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Blue Shield of California EPN |
$18.21
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Central Health Plan Commercial |
$27.29
|
| Rate for Payer: Cigna of CA HMO |
$23.88
|
| Rate for Payer: Cigna of CA PPO |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.64
|
| Rate for Payer: Galaxy Health WC |
$28.99
|
| Rate for Payer: Global Benefits Group Commercial |
$20.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$25.58
|
| Rate for Payer: Networks By Design Commercial |
$17.06
|
| Rate for Payer: Prime Health Services Commercial |
$28.99
|
|
|
HC SPLINT COLLES LG RT
|
Facility
OP
|
$34.11
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698123
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.15
|
| Rate for Payer: BCBS Transplant Transplant |
$20.47
|
| Rate for Payer: Blue Shield of California Commercial |
$25.58
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Central Health Plan Commercial |
$27.29
|
| Rate for Payer: Cigna of CA HMO |
$23.88
|
| Rate for Payer: Cigna of CA PPO |
$23.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.64
|
| Rate for Payer: Galaxy Health WC |
$28.99
|
| Rate for Payer: Global Benefits Group Commercial |
$20.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.58
|
| Rate for Payer: IEHP medi-cal |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$25.58
|
| Rate for Payer: Networks By Design Commercial |
$17.06
|
| Rate for Payer: Prime Health Services Commercial |
$28.99
|
| Rate for Payer: Riverside University Health MISP |
$13.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.06
|
| Rate for Payer: United Healthcare All Other HMO |
$17.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.99
|
| Rate for Payer: Vantage Medical Group Senior |
$28.99
|
|
|
HC SPLINT COLLES MED LT
|
Facility
IP
|
$33.78
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Shield of California EPN |
$18.04
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Central Health Plan Commercial |
$27.02
|
| Rate for Payer: Cigna of CA HMO |
$23.65
|
| Rate for Payer: Cigna of CA PPO |
$23.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.51
|
| Rate for Payer: Galaxy Health WC |
$28.71
|
| Rate for Payer: Global Benefits Group Commercial |
$20.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$25.34
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$28.71
|
|
