|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.60 |
| Max. Negotiated Rate |
$1,099.05 |
| Rate for Payer: Adventist Health Commercial |
$258.60
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: 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
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$258.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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: United Healthcare All Other Commercial |
$646.50
|
| Rate for Payer: United Healthcare All Other HMO |
$646.50
|
| Rate for Payer: United Healthcare HMO Rider |
$646.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.30 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$299.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| 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 |
$328.95
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Cigna of CA HMO |
$467.84
|
| Rate for Payer: Cigna of CA PPO |
$540.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$511.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$621.35
|
| Rate for Payer: Global Benefits Group Commercial |
$438.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: Networks By Design Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Commercial |
$621.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$438.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: Adventist Health Commercial |
$146.20
|
| Rate for Payer: Cash Price |
$328.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$511.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.40
|
| Rate for Payer: EPIC Health Plan Senior |
$292.40
|
| Rate for Payer: Galaxy Health WC |
$621.35
|
| Rate for Payer: Global Benefits Group Commercial |
$438.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$431.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.44
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: Networks By Design Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Commercial |
$621.35
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO |
$586.24
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$458.00
|
| Rate for Payer: United Healthcare HMO Rider |
$458.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$375.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO |
$586.24
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$549.60
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$540.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$540.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$540.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO |
$586.24
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$581.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.34
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Adventist Health Commercial |
$375.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| 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 |
$412.20
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| 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 |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| 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 |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| 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 |
$694.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 OF HIP SPICA CAST
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$208.32 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,139.54
|
| 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 |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| 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 |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| 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 |
$694.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| 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 APP OF INTERDENTAL FIXATION
|
Facility
|
IP
|
$4,830.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$4,105.50 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,381.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,932.00
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,067.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,849.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
|
|
HC APP OF INTERDENTAL FIXATION
|
Facility
|
OP
|
$4,830.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cash Price |
$2,173.50
|
| Rate for Payer: Cigna of CA HMO |
$3,091.20
|
| Rate for Payer: Cigna of CA PPO |
$3,574.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,381.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,067.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| 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 |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| 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 |
$647.20
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.50
|
| Rate for Payer: United Healthcare All Other HMO |
$404.50
|
| Rate for Payer: United Healthcare HMO Rider |
$404.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 OF LONG ARM SPLINT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$331.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.26
|
| 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 |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| 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 |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| 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 |
$647.20
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| 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 OF LONG ARM SPLINT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$331.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.26
|
| 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 |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| 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 |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC APP OF LONG ARM SPLINT MCAL
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC APP OF LONG ARM SPLINT MCAL
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.26
|
| 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 |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$595.20
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| 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 |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 APP OF LONG ARM SPLINT MCARE COM
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
