|
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: Adventist Health Commercial |
$13.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.33
|
| 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 Exchange |
$32.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$27.16
|
| Rate for Payer: Cash Price |
$37.43
|
| 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: Dignity Health Medi-Cal |
$57.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Senior |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.25
|
| Rate for Payer: InnovAge PACE Commercial |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.61
|
| 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 |
$51.05
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
| Rate for Payer: Riverside University Health System 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 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 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: Adventist Health Commercial |
$9.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.39
|
| 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 Exchange |
$22.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.45
|
| Rate for Payer: Blue Shield of California Commercial |
$28.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$25.71
|
| 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: Dignity Health Medi-Cal |
$39.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.70
|
| Rate for Payer: EPIC Health Plan Senior |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$39.73
|
| Rate for Payer: Global Benefits Group Commercial |
$28.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.07
|
| Rate for Payer: InnovAge PACE Commercial |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| 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 |
$35.05
|
| Rate for Payer: Networks By Design Commercial |
$30.38
|
| Rate for Payer: Prime Health Services Commercial |
$39.73
|
| Rate for Payer: Riverside University Health System 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 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 |
$42.07 |
| Rate for Payer: Adventist Health Commercial |
$9.35
|
| Rate for Payer: Cash Price |
$25.71
|
| Rate for Payer: Central Health Plan Commercial |
$37.39
|
| 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: Health Management Network EPO/PPO |
$42.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$35.05
|
| 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 |
$70.11 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Blue Shield of California Commercial |
$60.22
|
| Rate for Payer: Blue Shield of California EPN |
$39.26
|
| Rate for Payer: Cash Price |
$42.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| 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 |
$25.51 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$31.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.75
|
| Rate for Payer: Blue Shield of California Commercial |
$60.22
|
| Rate for Payer: Blue Shield of California EPN |
$39.26
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cash Price |
$42.85
|
| 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: Dignity Health Medi-Cal |
$66.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.01
|
| Rate for Payer: InnovAge PACE Commercial |
$38.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.94
|
| 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 |
$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 System 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 |
$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 3/4"
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901604176
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$4.13
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
|
|
HC SPLINT ALUMAFOAM 18 X 3/4"
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901604176
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| 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 |
$3.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$4.13
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: InnovAge PACE Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| 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 |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| 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 |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| 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 ALUMAFOAM 18" X .5"
|
Facility
|
OP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| 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 Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: InnovAge PACE Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| 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 |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Riverside University Health System MISP |
$2.95
|
| 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 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 |
$6.64 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| 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: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
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: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Blue Shield of California Commercial |
$71.15
|
| Rate for Payer: Blue Shield of California EPN |
$46.39
|
| Rate for Payer: Cash Price |
$50.62
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$35.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$69.03
|
| 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 ANKLE STIRRUP AIR/FOAM
|
Facility
|
OP
|
$92.04
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698313
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.14 |
| 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 |
$54.06
|
| Rate for Payer: Blue Shield of California Commercial |
$71.15
|
| Rate for Payer: Blue Shield of California EPN |
$46.39
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cash Price |
$50.62
|
| 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: Dignity Health Medi-Cal |
$78.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.23
|
| Rate for Payer: Global Benefits Group Commercial |
$55.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: InnovAge PACE Commercial |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.74
|
| 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 |
$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 System 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 |
$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 COCK-UP FOAM PAD LG
|
Facility
|
OP
|
$41.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$37.49 |
| Rate for Payer: Adventist Health Commercial |
$17.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.47
|
| Rate for Payer: Blue Shield of California Commercial |
$32.20
|
| Rate for Payer: Blue Shield of California EPN |
$21.00
|
| Rate for Payer: Cash Price |
$22.91
|
| 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: Dignity Health Medi-Cal |
$35.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.49
|
| Rate for Payer: InnovAge PACE Commercial |
$20.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| 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 |
$31.25
|
| Rate for Payer: Networks By Design Commercial |
$20.83
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: Riverside University Health System 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 |
$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 |
$37.49 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$32.20
|
| Rate for Payer: Blue Shield of California EPN |
$21.00
|
| Rate for Payer: Cash Price |
$22.91
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$31.25
|
| 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
|
OP
|
$50.43
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901607819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$45.39 |
| 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 |
$29.62
|
| Rate for Payer: Blue Shield of California Commercial |
$38.98
|
| Rate for Payer: Blue Shield of California EPN |
$25.42
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Central Health Plan Commercial |
$40.34
|
| 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: 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: Health Management Network EPO/PPO |
$45.39
|
| Rate for Payer: InnovAge PACE Commercial |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.68
|
| 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 |
$37.82
|
| Rate for Payer: Networks By Design Commercial |
$25.21
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: Riverside University Health System MISP |
$20.17
|
| 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 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 |
$45.39 |
| Rate for Payer: Adventist Health Commercial |
$10.09
|
| Rate for Payer: Blue Shield of California Commercial |
$38.98
|
| Rate for Payer: Blue Shield of California EPN |
$25.42
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Central Health Plan Commercial |
$40.34
|
| Rate for Payer: Cigna of CA HMO |
$35.30
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$45.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.09
|
| Rate for Payer: Multiplan Commercial |
$37.82
|
| 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
|
|
|
HC SPLINT COLLES LG LT
|
Facility
|
OP
|
$31.24
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698121
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$12.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.35
|
| Rate for Payer: Blue Shield of California Commercial |
$24.15
|
| Rate for Payer: Blue Shield of California EPN |
$15.74
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Central Health Plan Commercial |
$24.99
|
| Rate for Payer: Cigna of CA HMO |
$21.87
|
| Rate for Payer: Cigna of CA PPO |
$21.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$23.43
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.55
|
| Rate for Payer: Riverside University Health System MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.55
|
| Rate for Payer: Vantage Medical Group Senior |
$26.55
|
|
|
HC SPLINT COLLES LG LT
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698121
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Blue Shield of California Commercial |
$24.15
|
| Rate for Payer: Blue Shield of California EPN |
$15.74
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Central Health Plan Commercial |
$24.99
|
| Rate for Payer: Cigna of CA HMO |
$21.87
|
| Rate for Payer: Cigna of CA PPO |
$21.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.43
|
| Rate for Payer: Networks By Design Commercial |
$20.31
|
| Rate for Payer: Prime Health Services Commercial |
$26.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.23
|
|
|
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 |
$31.66 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$26.39
|
| 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 |
$11.52 |
| 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 |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| 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: 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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.42
|
| 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 |
$26.39
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Riverside University Health System MISP |
$14.07
|
| 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
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.52 |
| 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 |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| 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: 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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.42
|
| 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 |
$26.39
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Riverside University Health System MISP |
$14.07
|
| 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
|
IP
|
$35.18
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$31.66 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$26.39
|
| 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 |
$11.52 |
| 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 |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| 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: 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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.42
|
| 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 |
$26.39
|
| Rate for Payer: Networks By Design Commercial |
$17.59
|
| Rate for Payer: Prime Health Services Commercial |
$29.90
|
| Rate for Payer: Riverside University Health System MISP |
$14.07
|
| 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 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 |
$31.66 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$27.19
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$28.14
|
| Rate for Payer: Cigna of CA HMO |
$24.63
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$31.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$26.39
|
| 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 SM LT
|
Facility
|
IP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698118
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$23.01
|
| Rate for Payer: Blue Shield of California EPN |
$15.00
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
|
|
HC SPLINT COLLES SM LT
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698118
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.48
|
| Rate for Payer: Blue Shield of California Commercial |
$23.01
|
| Rate for Payer: Blue Shield of California EPN |
$15.00
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Riverside University Health System MISP |
$11.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
