|
HC SPLINT FROG SMALL
|
Facility
OP
|
$5.74
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606405
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: BCBS Transplant Transplant |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.30
|
| Rate for Payer: IEHP medi-cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: Riverside University Health MISP |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC SPLINT FROG SMALL
|
Facility
IP
|
$5.74
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606405
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC SPLINT PLASTER 3X15 50/BX
|
Facility
OP
|
$2.87
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.15
|
| Rate for Payer: IEHP medi-cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: Riverside University Health MISP |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
HC SPLINT PLASTER 3X15 50/BX
|
Facility
IP
|
$2.87
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
IP
|
$1.15
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
OP
|
$1.15
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.68
|
| Rate for Payer: BCBS Transplant Transplant |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
IP
|
$2.30
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.72
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
905352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Blue Shield of California EPN |
$260.59
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
905352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$318.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$268.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.31
|
| Rate for Payer: BCBS Transplant Transplant |
$292.80
|
| Rate for Payer: Blue Shield of California Commercial |
$366.00
|
| Rate for Payer: Blue Shield of California EPN |
$265.47
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$366.00
|
| Rate for Payer: IEHP medi-cal |
$170.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Riverside University Health MISP |
$195.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.00
|
| Rate for Payer: United Healthcare All Other HMO |
$244.00
|
| Rate for Payer: United Healthcare HMO Rider |
$244.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
IP
|
$961.40
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$865.26 |
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$769.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.56
|
| Rate for Payer: Galaxy Health WC |
$817.19
|
| Rate for Payer: Global Benefits Group Commercial |
$576.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$721.05
|
| Rate for Payer: Networks By Design Commercial |
$624.91
|
| Rate for Payer: Prime Health Services Commercial |
$817.19
|
|
|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
OP
|
$961.40
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$865.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$583.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$817.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$528.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$465.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.00
|
| Rate for Payer: BCBS Transplant Transplant |
$576.84
|
| Rate for Payer: Blue Shield of California Commercial |
$604.72
|
| Rate for Payer: Blue Shield of California EPN |
$470.12
|
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$769.12
|
| Rate for Payer: Cigna of CA HMO |
$615.30
|
| Rate for Payer: Cigna of CA PPO |
$711.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$817.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.56
|
| Rate for Payer: Galaxy Health WC |
$817.19
|
| Rate for Payer: Global Benefits Group Commercial |
$576.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$721.05
|
| Rate for Payer: IEHP medi-cal |
$336.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$721.05
|
| Rate for Payer: Networks By Design Commercial |
$624.91
|
| Rate for Payer: Prime Health Services Commercial |
$817.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$576.84
|
| Rate for Payer: Riverside University Health MISP |
$384.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.70
|
| Rate for Payer: United Healthcare All Other HMO |
$480.70
|
| Rate for Payer: United Healthcare HMO Rider |
$480.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.19
|
| Rate for Payer: Vantage Medical Group Senior |
$817.19
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
OP
|
$1,237.40
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$247.48 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$751.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,051.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$680.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$680.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$599.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.06
|
| Rate for Payer: BCBS Transplant Transplant |
$742.44
|
| Rate for Payer: Blue Shield of California Commercial |
$778.32
|
| Rate for Payer: Blue Shield of California EPN |
$605.09
|
| Rate for Payer: Cash Price |
$556.83
|
| Rate for Payer: Central Health Plan Commercial |
$989.92
|
| Rate for Payer: Cigna of CA HMO |
$791.94
|
| Rate for Payer: Cigna of CA PPO |
$915.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,051.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$494.96
|
| Rate for Payer: Galaxy Health WC |
$1,051.79
|
| Rate for Payer: Global Benefits Group Commercial |
$742.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$928.05
|
| Rate for Payer: IEHP medi-cal |
$433.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$928.05
|
| Rate for Payer: Networks By Design Commercial |
$804.31
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$742.44
|
| Rate for Payer: Riverside University Health MISP |
$494.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$742.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$618.70
|
| Rate for Payer: United Healthcare All Other HMO |
$618.70
|
| Rate for Payer: United Healthcare HMO Rider |
$618.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$618.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,051.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1,051.79
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
IP
|
$1,237.40
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$247.48 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Cash Price |
$556.83
|
| Rate for Payer: Central Health Plan Commercial |
$989.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.96
|
| Rate for Payer: Galaxy Health WC |
$1,051.79
|
| Rate for Payer: Global Benefits Group Commercial |
$742.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$928.05
|
| Rate for Payer: Networks By Design Commercial |
$804.31
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.79
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
OP
|
$37.23
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.00
|
| Rate for Payer: BCBS Transplant Transplant |
$22.34
|
| Rate for Payer: Blue Shield of California Commercial |
$23.42
|
| Rate for Payer: Blue Shield of California EPN |
$18.21
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Central Health Plan Commercial |
$29.78
|
| Rate for Payer: Cigna of CA HMO |
$23.83
|
| Rate for Payer: Cigna of CA PPO |
$27.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$31.65
|
| Rate for Payer: Global Benefits Group Commercial |
$22.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.92
|
| Rate for Payer: IEHP medi-cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
| Rate for Payer: Networks By Design Commercial |
$24.20
|
| Rate for Payer: Prime Health Services Commercial |
$31.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.34
|
| Rate for Payer: Riverside University Health MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.62
|
| Rate for Payer: United Healthcare All Other HMO |
$18.62
|
| Rate for Payer: United Healthcare HMO Rider |
$18.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.65
|
| Rate for Payer: Vantage Medical Group Senior |
$31.65
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
IP
|
$37.23
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Central Health Plan Commercial |
$29.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$31.65
|
| Rate for Payer: Global Benefits Group Commercial |
$22.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
| Rate for Payer: Networks By Design Commercial |
$24.20
|
| Rate for Payer: Prime Health Services Commercial |
$31.65
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
IP
|
$46.58
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$41.92 |
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Central Health Plan Commercial |
$37.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.32
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
OP
|
$46.58
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.52
|
| Rate for Payer: BCBS Transplant Transplant |
$27.95
|
| Rate for Payer: Blue Shield of California Commercial |
$29.30
|
| Rate for Payer: Blue Shield of California EPN |
$22.78
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Central Health Plan Commercial |
$37.26
|
| Rate for Payer: Cigna of CA HMO |
$29.81
|
| Rate for Payer: Cigna of CA PPO |
$34.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.94
|
| Rate for Payer: IEHP medi-cal |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.32
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.95
|
| Rate for Payer: Riverside University Health MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.29
|
| Rate for Payer: United Healthcare All Other HMO |
$23.29
|
| Rate for Payer: United Healthcare HMO Rider |
$23.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.59
|
| Rate for Payer: Vantage Medical Group Senior |
$39.59
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
IP
|
$23.70
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Central Health Plan Commercial |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
OP
|
$23.70
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.00
|
| Rate for Payer: BCBS Transplant Transplant |
$14.22
|
| Rate for Payer: Blue Shield of California Commercial |
$14.91
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Central Health Plan Commercial |
$18.96
|
| Rate for Payer: Cigna of CA HMO |
$15.17
|
| Rate for Payer: Cigna of CA PPO |
$17.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.78
|
| Rate for Payer: IEHP medi-cal |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.22
|
| Rate for Payer: Riverside University Health MISP |
$9.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$2,163.60 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,163.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,442.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,923.20
|
| Rate for Payer: Cigna of CA PPO |
$1,778.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,163.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,803.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,442.40
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,442.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPUTUM COLLECTION
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$219.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$274.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: IEHP medi-cal |
$352.13
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Innovage PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: Riverside University Health MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SPUTUM COLLECTION
|
Facility
IP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC SSA AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.13
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: IEHP medi-cal |
$29.58
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Innovage PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
