|
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: Kaiser Permanente of CA Medi-Cal |
$12.87
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.15
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
OP
|
$30.01
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Blue Distinction Transplant |
$18.01
|
| Rate for Payer: Blue Shield of California Commercial |
$22.51
|
| Rate for Payer: Blue Shield of California EPN |
$16.33
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.01
|
| Rate for Payer: Cigna of CA HMO |
$21.01
|
| Rate for Payer: Cigna of CA PPO |
$21.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.51
|
| Rate for Payer: Dignity Health Media |
$25.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.30
|
| Rate for Payer: Multiplan Commercial |
$22.51
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.51
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.51
|
| Rate for Payer: Vantage Medical Group Senior |
$25.51
|
|
|
HC SPLINT COLLES MED RT
|
Facility
|
IP
|
$30.01
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698122
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.01 |
| Rate for Payer: Blue Shield of California EPN |
$16.03
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.01
|
| Rate for Payer: Cigna of CA HMO |
$21.01
|
| Rate for Payer: Cigna of CA PPO |
$21.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.51
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Other HMO |
$11.07
|
| Rate for Payer: United Healthcare HMO Rider |
$10.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.09
|
| Rate for Payer: Blue Distinction Transplant |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.09
|
| Rate for Payer: Blue Distinction Transplant |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.09
|
| Rate for Payer: Blue Distinction Transplant |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.33
|
| Rate for Payer: Blue Distinction Transplant |
$5.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Blue Shield of California EPN |
$4.41
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$6.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.67
|
| Rate for Payer: Dignity Health Media |
$7.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
| Rate for Payer: Riverside University Health System MISP |
$3.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
|
|
HC SPLINT FINGER LG CURVED 6"
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Distinction Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Media |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC SPLINT FINGER LG CURVED 6"
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
HC SPLINT FINGER MEDIUM CURVED 3"
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Distinction Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Media |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC SPLINT FINGER MEDIUM CURVED 3"
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
HC SPLINT FINGER OPEN PADDED 2.5"
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606411
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: Blue Distinction Transplant |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Media |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC SPLINT FINGER OPEN PADDED 2.5"
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606411
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Distinction Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Media |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
HC SPLINT FINGER SM. CURVED 1.5"
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Distinction Transplant |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Media |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC SPLINT FINGER SM. CURVED 1.5"
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
|
|
HC SPLINT FROG LARGE
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606407
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Distinction Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SPLINT FROG LARGE
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606407
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC SPLINT FROG MEDIUM
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606406
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Distinction Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SPLINT FROG MEDIUM
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606406
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
