|
HC APP OF LONG LEG CAST BRACE
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC APP OF LONG LEG CAST BRACE
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| 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 |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| 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 |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| 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 |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| 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 |
$853.60
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.50
|
| 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 SHORT ARM CAST
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| 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 |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| 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 |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| 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 |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.76
|
| 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 |
$739.20
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.00
|
| Rate for Payer: United Healthcare All Other HMO |
$462.00
|
| Rate for Payer: United Healthcare HMO Rider |
$462.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.00
|
| 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 SHORT ARM CAST
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$785.40 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$739.20
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| 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 |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| 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 |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| 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 |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| 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 |
$845.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$528.50
|
| Rate for Payer: United Healthcare HMO Rider |
$528.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.50
|
| 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 SHORT ARM SPLINT MCAL
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$1,032.75 |
| Rate for Payer: Adventist Health Commercial |
$243.00
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: EPIC Health Plan Senior |
$486.00
|
| Rate for Payer: Galaxy Health WC |
$1,032.75
|
| Rate for Payer: Global Benefits Group Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$752.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.60
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$789.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,032.75
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$498.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$796.92
|
| 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 |
$546.75
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cigna of CA HMO |
$777.60
|
| Rate for Payer: Cigna of CA PPO |
$899.10
|
| 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 |
$1,032.75
|
| Rate for Payer: Global Benefits Group Commercial |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.60
|
| 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 |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$789.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,032.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.00
|
| 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 SHORT ARM SPLINT MCARE COMM
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$1,032.75 |
| Rate for Payer: Adventist Health Commercial |
$243.00
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: EPIC Health Plan Senior |
$486.00
|
| Rate for Payer: Galaxy Health WC |
$1,032.75
|
| Rate for Payer: Global Benefits Group Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$752.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.60
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$789.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,032.75
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$498.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$796.92
|
| 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 |
$546.75
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Cigna of CA HMO |
$777.60
|
| Rate for Payer: Cigna of CA PPO |
$899.10
|
| 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 |
$1,032.75
|
| Rate for Payer: Global Benefits Group Commercial |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.60
|
| 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 |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$789.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,032.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.00
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.21 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$284.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.19
|
| 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 |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$444.16
|
| Rate for Payer: Cigna of CA PPO |
$513.56
|
| 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 |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| 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 |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$182.60
|
| 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 |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| 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 |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| 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 |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.12
|
| 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 |
$730.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.50
|
| Rate for Payer: United Healthcare HMO Rider |
$456.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$456.50
|
| 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 SHORT LEG CAST
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$776.05 |
| Rate for Payer: Adventist Health Commercial |
$182.60
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: EPIC Health Plan Senior |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$565.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.12
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| 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 |
$513.90
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna of CA HMO |
$730.88
|
| Rate for Payer: Cigna of CA PPO |
$845.08
|
| 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 |
$970.70
|
| Rate for Payer: Global Benefits Group Commercial |
$685.20
|
| 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 |
$761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.08
|
| 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 |
$913.60
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$742.30
|
| Rate for Payer: Prime Health Services Commercial |
$970.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$685.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$571.00
|
| Rate for Payer: United Healthcare All Other HMO |
$571.00
|
| Rate for Payer: United Healthcare HMO Rider |
$571.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$571.00
|
| 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 SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$970.70 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$456.80
|
| Rate for Payer: Galaxy Health WC |
$970.70
|
| Rate for Payer: Global Benefits Group Commercial |
$685.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$706.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.08
|
| Rate for Payer: Multiplan Commercial |
$913.60
|
| Rate for Payer: Networks By Design Commercial |
$742.30
|
| Rate for Payer: Prime Health Services Commercial |
$970.70
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| 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 |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$720.00
|
| Rate for Payer: Cigna of CA PPO |
$832.50
|
| 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 |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| 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 |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| 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 |
$900.00
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.50
|
| 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 SHORT LEG SPLINT
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$81.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| 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 |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$169.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.30
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| 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 |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$8,197.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,639.40 |
| Max. Negotiated Rate |
$6,967.45 |
| Rate for Payer: Adventist Health Commercial |
$1,639.40
|
| Rate for Payer: Cash Price |
$3,688.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,278.80
|
| Rate for Payer: Galaxy Health WC |
$6,967.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,918.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,073.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.28
|
| Rate for Payer: Multiplan Commercial |
$6,557.60
|
| Rate for Payer: Networks By Design Commercial |
$5,328.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,967.45
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$11,089.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,217.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$4,990.05
|
| Rate for Payer: Cash Price |
$4,990.05
|
| Rate for Payer: Cash Price |
$4,990.05
|
| Rate for Payer: Cigna of CA HMO |
$7,096.96
|
| Rate for Payer: Cigna of CA PPO |
$8,205.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,425.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,653.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,396.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,871.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,207.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,425.65
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$11,089.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,217.80 |
| Max. Negotiated Rate |
$9,425.65 |
| Rate for Payer: Cash Price |
$4,990.05
|
| Rate for Payer: Adventist Health Commercial |
$2,217.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,435.60
|
| Rate for Payer: Galaxy Health WC |
$9,425.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,653.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,396.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,224.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.36
|
| Rate for Payer: Multiplan Commercial |
$8,871.20
|
| Rate for Payer: Networks By Design Commercial |
$7,207.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,425.65
|
|
