|
HC APLS IGA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.42
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APLS IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$211.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Media |
$25.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$41.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC APLS IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.42
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.56
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$626.40
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna of CA PPO |
$772.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$626.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other HMO |
$522.00
|
| Rate for Payer: United Healthcare HMO Rider |
$522.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APPLICATION HAND WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION HAND WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$389.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$318.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$389.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$318.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$603.60
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$754.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC APP LONG LEG CAST
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.83 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$884.40
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.00
|
| Rate for Payer: United Healthcare All Other HMO |
$737.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$837.60
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna of CA PPO |
$1,033.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$1,186.60
|
| Rate for Payer: Global Benefits Group Commercial |
$837.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,047.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$1,116.80
|
| Rate for Payer: Networks By Design Commercial |
$907.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,186.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$837.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.00
|
| Rate for Payer: United Healthcare All Other HMO |
$698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$698.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$698.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.04 |
| Max. Negotiated Rate |
$1,186.60 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.40
|
| Rate for Payer: Galaxy Health WC |
$1,186.60
|
| Rate for Payer: Global Benefits Group Commercial |
$837.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.04
|
| Rate for Payer: Multiplan Commercial |
$1,116.80
|
| Rate for Payer: Networks By Design Commercial |
$907.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,186.60
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.00
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,838.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,892.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,892.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,892.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,892.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
IP
|
$3,785.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$908.40 |
| Max. Negotiated Rate |
$3,217.25 |
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,514.00
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,442.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.04 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.40
|
| Rate for Payer: Galaxy Health WC |
$1,292.85
|
| Rate for Payer: Global Benefits Group Commercial |
$912.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,014.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$1,216.80
|
| Rate for Payer: Networks By Design Commercial |
$988.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.85
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$912.60
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cigna of CA PPO |
$1,125.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$1,292.85
|
| Rate for Payer: Global Benefits Group Commercial |
$912.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,140.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,014.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$1,216.80
|
| Rate for Payer: Networks By Design Commercial |
$988.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$912.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$760.50
|
| Rate for Payer: United Healthcare All Other HMO |
$760.50
|
| Rate for Payer: United Healthcare HMO Rider |
$760.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$760.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$448.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna of CA HMO |
$478.72
|
| Rate for Payer: Cigna of CA PPO |
$553.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$561.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$635.80 |
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.20
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.52
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$710.40
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.00
|
| Rate for Payer: United Healthcare All Other HMO |
$592.00
|
| Rate for Payer: United Healthcare HMO Rider |
$592.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.16 |
| Max. Negotiated Rate |
$1,006.40 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.16
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
