|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.20 |
| Max. Negotiated Rate |
$1,224.85 |
| Rate for Payer: Adventist Health Commercial |
$288.20
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.40
|
| Rate for Payer: EPIC Health Plan Senior |
$576.40
|
| Rate for Payer: Galaxy Health WC |
$1,224.85
|
| Rate for Payer: Global Benefits Group Commercial |
$864.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$961.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.84
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: Networks By Design Commercial |
$936.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.85
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$593.50
|
| Rate for Payer: United Healthcare All Other HMO |
$593.50
|
| Rate for Payer: United Healthcare HMO Rider |
$593.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$593.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
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 |
$757.00 |
| Max. Negotiated Rate |
$3,217.25 |
| Rate for Payer: Adventist Health Commercial |
$757.00
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,514.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$2,524.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,442.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,342.91
|
| 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 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: Adventist Health Commercial |
$757.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 HMO |
$2,422.40
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| 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: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$258.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: Cigna of CA HMO |
$827.52
|
| Rate for Payer: Cigna of CA PPO |
$956.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$1,099.05
|
| Rate for Payer: Global Benefits Group Commercial |
$775.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$862.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$840.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.05
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$646.50
|
| Rate for Payer: United Healthcare All Other HMO |
$646.50
|
| Rate for Payer: United Healthcare HMO Rider |
$646.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.60 |
| Max. Negotiated Rate |
$1,099.05 |
| Rate for Payer: Adventist Health Commercial |
$258.60
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.20
|
| Rate for Payer: EPIC Health Plan Senior |
$517.20
|
| Rate for Payer: Galaxy Health WC |
$1,099.05
|
| Rate for Payer: Global Benefits Group Commercial |
$775.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$862.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$800.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.32
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: Networks By Design Commercial |
$840.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.05
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.30 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$299.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$479.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cigna of CA HMO |
$467.84
|
| Rate for Payer: Cigna of CA PPO |
$540.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$621.35
|
| Rate for Payer: Global Benefits Group Commercial |
$438.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$487.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: Networks By Design Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Commercial |
$621.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$438.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: Adventist Health Commercial |
$146.20
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.40
|
| Rate for Payer: EPIC Health Plan Senior |
$292.40
|
| Rate for Payer: Galaxy Health WC |
$621.35
|
| Rate for Payer: Global Benefits Group Commercial |
$438.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$487.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$452.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.44
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: Networks By Design Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Commercial |
$621.35
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO |
$586.24
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$458.00
|
| Rate for Payer: United Healthcare HMO Rider |
$458.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$375.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$600.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO |
$586.24
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APP OF INTERDENTAL FIXATION
|
Facility
|
OP
|
$4,830.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cigna of CA HMO |
$3,091.20
|
| Rate for Payer: Cigna of CA PPO |
$3,574.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,221.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC APP OF INTERDENTAL FIXATION
|
Facility
|
IP
|
$4,830.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$4,105.50 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,932.00
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,221.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,989.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$331.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.50
|
| Rate for Payer: United Healthcare All Other HMO |
$404.50
|
| Rate for Payer: United Healthcare HMO Rider |
$404.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC APP OF LONG ARM SPLINT MCAL
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC APP OF LONG ARM SPLINT MCAL
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$609.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$595.20
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP OF LONG ARM SPLINT MCARE COM
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC APP OF LONG ARM SPLINT MCARE COM
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$609.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$595.20
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
