|
HC SPLINT FROG SMALL
|
Facility
|
IP
|
$7.38
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901606405
|
|
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 PLASTER 3X15 50/BX
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
HC SPLINT PLASTER 3X15 50/BX
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605167
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: InnovAge PACE Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: InnovAge PACE Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1.18
|
|
|
HC SPLINT PLASTER 4X15 50/BX
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
|
|
HC SPLINT PLASTER 5X30 50/BX
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$2.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: InnovAge PACE Commercial |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC SPLINT SLING ARM MED
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.37
|
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Central Health Plan Commercial |
$16.85
|
| Rate for Payer: Cigna of CA HMO |
$14.74
|
| Rate for Payer: Cigna of CA PPO |
$14.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.95
|
| Rate for Payer: InnovAge PACE Commercial |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.74
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
| Rate for Payer: Riverside University Health System MISP |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SPLINT SLING ARM MED
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Central Health Plan Commercial |
$16.85
|
| Rate for Payer: Cigna of CA HMO |
$14.74
|
| Rate for Payer: Cigna of CA PPO |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
| Rate for Payer: Networks By Design Commercial |
$13.69
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$7.69
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
915352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.02 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| 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: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$93.02
|
| Rate for Payer: InnovAge PACE Commercial |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
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: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| 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 |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
905352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.02 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| 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: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$93.02
|
| Rate for Payer: InnovAge PACE Commercial |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC SPLIT FLAT CALIPER STIRRUPS
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L2230
|
| Hospital Charge Code |
915352230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Blue Shield of California Commercial |
$377.22
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$268.40
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| 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 |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: InnovAge PACE Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
|
OP
|
$33.95
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Blue Shield of California EPN |
$13.55
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$27.16
|
| Rate for Payer: Cigna of CA HMO |
$21.73
|
| Rate for Payer: Cigna of CA PPO |
$25.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.55
|
| Rate for Payer: InnovAge PACE Commercial |
$16.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.77
|
| Rate for Payer: Multiplan Commercial |
$25.46
|
| Rate for Payer: Networks By Design Commercial |
$22.07
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
| Rate for Payer: Riverside University Health System MISP |
$13.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.98
|
| Rate for Payer: United Healthcare All Other HMO |
$16.98
|
| Rate for Payer: United Healthcare HMO Rider |
$16.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28.86
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
|
IP
|
$33.95
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$27.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$25.46
|
| Rate for Payer: Networks By Design Commercial |
$22.07
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
|
IP
|
$40.75
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Adventist Health Commercial |
$8.15
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Central Health Plan Commercial |
$32.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.30
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$34.64
|
| Rate for Payer: Global Benefits Group Commercial |
$24.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$30.56
|
| Rate for Payer: Networks By Design Commercial |
$26.49
|
| Rate for Payer: Prime Health Services Commercial |
$34.64
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
|
OP
|
$40.75
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Adventist Health Commercial |
$8.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.93
|
| Rate for Payer: Blue Shield of California Commercial |
$24.90
|
| Rate for Payer: Blue Shield of California EPN |
$16.26
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Central Health Plan Commercial |
$32.60
|
| Rate for Payer: Cigna of CA HMO |
$26.08
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.30
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$34.64
|
| Rate for Payer: Global Benefits Group Commercial |
$24.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.67
|
| Rate for Payer: InnovAge PACE Commercial |
$20.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$30.56
|
| Rate for Payer: Networks By Design Commercial |
$26.49
|
| Rate for Payer: Prime Health Services Commercial |
$34.64
|
| Rate for Payer: Riverside University Health System MISP |
$16.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.38
|
| Rate for Payer: United Healthcare All Other HMO |
$20.38
|
| Rate for Payer: United Healthcare HMO Rider |
$20.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Vantage Medical Group Senior |
$34.64
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$28.11
|
| Rate for Payer: Blue Shield of California EPN |
$18.35
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: InnovAge PACE Commercial |
$23.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Riverside University Health System MISP |
$18.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.10
|
| Rate for Payer: Vantage Medical Group Senior |
$39.10
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$4.14
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.07
|
| Rate for Payer: Galaxy Health WC |
$4.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.65
|
| Rate for Payer: InnovAge PACE Commercial |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$3.36
|
| Rate for Payer: Prime Health Services Commercial |
$4.39
|
| Rate for Payer: Riverside University Health System MISP |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.39
|
| Rate for Payer: Vantage Medical Group Senior |
$4.39
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.07
|
| Rate for Payer: Galaxy Health WC |
$4.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.88
|
| Rate for Payer: Networks By Design Commercial |
$3.36
|
| Rate for Payer: Prime Health Services Commercial |
$4.39
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.19 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,544.00
|
| Rate for Payer: Cigna of CA HMO |
$2,035.20
|
| Rate for Payer: Cigna of CA PPO |
$2,353.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,862.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$409.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,385.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,908.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,862.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,272.00
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,862.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,968.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.00
|
| Rate for Payer: Multiplan Commercial |
$2,385.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
|
