|
HC APPLICATION HAND WRIST CAST
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$140.11 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$398.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$573.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$573.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$398.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$140.11 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$398.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$573.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$403.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$434.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC APP LONG LEG CAST
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$235.83 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Adventist Health Commercial |
$590.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cigna of CA HMO |
$922.24
|
| Rate for Payer: Cigna of CA PPO |
$1,066.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,008.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,224.85
|
| Rate for Payer: Global Benefits Group Commercial |
$864.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$915.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$936.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.85
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,008.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$915.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$850.19
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,008.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$915.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$850.19
|
| 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 CAST
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.83 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$288.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cigna of CA HMO |
$922.24
|
| Rate for Payer: Cigna of CA PPO |
$1,066.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,008.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,224.85
|
| Rate for Payer: Global Benefits Group Commercial |
$864.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$915.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$936.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.85
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$720.50
|
| Rate for Payer: United Healthcare All Other HMO |
$720.50
|
| Rate for Payer: United Healthcare HMO Rider |
$720.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| 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: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$700.33
|
| 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 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 |
$5,641.00 |
| 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 |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| 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/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$486.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| 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/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| 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: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$700.33
|
| 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
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
| Rate for Payer: Adventist Health Commercial |
$757.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,649.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| 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/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,403.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
IP
|
$3,785.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,649.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,403.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,233.15
|
| 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
|
456
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,551.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,952.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,649.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| 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/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,403.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| 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: TriValley Medical Group Commercial/Senior |
$2,271.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,649.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,403.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,233.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$905.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$821.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.87
|
| 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 FIGURE EIGHT
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$530.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$419.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$905.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| 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/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$821.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| 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: TriValley Medical Group Commercial/Senior |
$775.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
