|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$921.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$835.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$776.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$1,331.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$545.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$383.85
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Cigna of CA HMO |
$851.84
|
| Rate for Payer: Cigna of CA PPO |
$984.94
|
| 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 |
$931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$798.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,197.90
|
| 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 |
$845.18
|
| 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 |
$266.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$998.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$865.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,131.35
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$798.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$798.60
|
| 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 APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$1,331.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$1,197.90 |
| Rate for Payer: Adventist Health Commercial |
$266.20
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$532.40
|
| Rate for Payer: EPIC Health Plan Senior |
$532.40
|
| Rate for Payer: Galaxy Health WC |
$1,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$798.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,197.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$845.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$785.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.20
|
| Rate for Payer: Multiplan Commercial |
$998.25
|
| Rate for Payer: Networks By Design Commercial |
$865.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,131.35
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$1,331.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$1,197.90 |
| Rate for Payer: Adventist Health Commercial |
$266.20
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$532.40
|
| Rate for Payer: EPIC Health Plan Senior |
$532.40
|
| Rate for Payer: Galaxy Health WC |
$1,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$798.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,197.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$845.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$785.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.20
|
| Rate for Payer: Multiplan Commercial |
$998.25
|
| Rate for Payer: Networks By Design Commercial |
$865.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,131.35
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$1,331.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$266.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Cigna of CA HMO |
$851.84
|
| Rate for Payer: Cigna of CA PPO |
$984.94
|
| 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 |
$931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$798.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,197.90
|
| 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 |
$845.18
|
| 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 |
$266.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$998.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$865.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,131.35
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$798.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$665.50
|
| Rate for Payer: United Healthcare All Other HMO |
$665.50
|
| Rate for Payer: United Healthcare HMO Rider |
$665.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$665.50
|
| 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 CAST
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$235.83 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$799.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.02
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: Cigna of CA HMO |
$1,247.36
|
| Rate for Payer: Cigna of CA PPO |
$1,442.26
|
| 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 |
$1,364.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| 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 |
$1,237.62
|
| 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 |
$389.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.40
|
| 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 |
$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
|
$1,949.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$389.80 |
| Max. Negotiated Rate |
$1,754.10 |
| Rate for Payer: Adventist Health Commercial |
$389.80
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,364.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.60
|
| Rate for Payer: EPIC Health Plan Senior |
$779.60
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,237.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,149.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
|
|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.80 |
| Max. Negotiated Rate |
$1,754.10 |
| Rate for Payer: Adventist Health Commercial |
$389.80
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,364.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.60
|
| Rate for Payer: EPIC Health Plan Senior |
$779.60
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,237.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,149.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
|
|
HC APP LONG LEG CAST
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.83 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$389.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Cash Price |
$877.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,559.20
|
| Rate for Payer: Cigna of CA HMO |
$1,247.36
|
| Rate for Payer: Cigna of CA PPO |
$1,442.26
|
| 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 |
$1,364.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,656.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,754.10
|
| 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 |
$1,237.62
|
| 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 |
$389.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,461.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,266.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,656.65
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$974.50
|
| Rate for Payer: United Healthcare All Other HMO |
$974.50
|
| Rate for Payer: United Healthcare HMO Rider |
$974.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$974.50
|
| 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
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Cigna of CA HMO |
$848.64
|
| Rate for Payer: Cigna of CA PPO |
$981.24
|
| 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 |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| 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 |
$842.01
|
| 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 |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.00
|
| 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
|
$1,326.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$782.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$543.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$268.68
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Cigna of CA HMO |
$848.64
|
| Rate for Payer: Cigna of CA PPO |
$981.24
|
| 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 |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| 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 |
$842.01
|
| 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 |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$795.60
|
| 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 |
$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
|
$1,326.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$782.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
OP
|
$5,672.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,134.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,537.60
|
| Rate for Payer: Cigna of CA HMO |
$3,630.08
|
| Rate for Payer: Cigna of CA PPO |
$4,197.28
|
| 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 |
$3,970.40
|
| 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 |
$4,821.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,403.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,104.80
|
| 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 |
$3,601.72
|
| 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 |
$1,134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,686.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$4,821.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,403.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,836.00
|
| 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
|
$5,672.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,134.40 |
| Max. Negotiated Rate |
$5,104.80 |
| Rate for Payer: Adventist Health Commercial |
$1,134.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,537.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,970.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,268.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,268.80
|
| Rate for Payer: Galaxy Health WC |
$4,821.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,403.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,104.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,601.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,346.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.40
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
| Rate for Payer: Networks By Design Commercial |
$3,686.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,821.20
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
OP
|
$5,672.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$2,325.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,605.83
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,537.60
|
| Rate for Payer: Cigna of CA HMO |
$3,630.08
|
| Rate for Payer: Cigna of CA PPO |
$4,197.28
|
| 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 |
$3,970.40
|
| 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 |
$4,821.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,403.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,104.80
|
| 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 |
$3,601.72
|
| 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 |
$1,134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,686.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$4,821.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,403.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,403.20
|
| 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 |
$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
|
$5,672.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,134.40 |
| Max. Negotiated Rate |
$5,104.80 |
| Rate for Payer: Adventist Health Commercial |
$1,134.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,537.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,970.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,268.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,268.80
|
| Rate for Payer: Galaxy Health WC |
$4,821.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,403.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,104.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,601.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,346.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.40
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
| Rate for Payer: Networks By Design Commercial |
$3,686.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,821.20
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$824.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.66
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.80
|
| Rate for Payer: Cigna of CA HMO |
$1,287.04
|
| Rate for Payer: Cigna of CA PPO |
$1,488.14
|
| 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 |
$1,407.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,709.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.90
|
| 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 |
$1,276.98
|
| 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 |
$402.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,508.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,307.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,709.35
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,206.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,206.60
|
| 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 OF FIGURE EIGHT
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$402.20 |
| Max. Negotiated Rate |
$1,809.90 |
| Rate for Payer: Adventist Health Commercial |
$402.20
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,407.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$804.40
|
| Rate for Payer: EPIC Health Plan Senior |
$804.40
|
| Rate for Payer: Galaxy Health WC |
$1,709.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,276.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,186.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.20
|
| Rate for Payer: Multiplan Commercial |
$1,508.25
|
| Rate for Payer: Networks By Design Commercial |
$1,307.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,709.35
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.20 |
| Max. Negotiated Rate |
$1,809.90 |
| Rate for Payer: Adventist Health Commercial |
$402.20
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,407.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$804.40
|
| Rate for Payer: EPIC Health Plan Senior |
$804.40
|
| Rate for Payer: Galaxy Health WC |
$1,709.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,276.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,186.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.20
|
| Rate for Payer: Multiplan Commercial |
$1,508.25
|
| Rate for Payer: Networks By Design Commercial |
$1,307.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,709.35
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$402.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Cash Price |
$904.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.80
|
| Rate for Payer: Cigna of CA HMO |
$1,287.04
|
| Rate for Payer: Cigna of CA PPO |
$1,488.14
|
| 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 |
$1,407.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,709.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.90
|
| 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 |
$1,276.98
|
| 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 |
$402.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,508.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,307.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,709.35
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,005.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,005.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,005.50
|
| 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
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903208876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$405.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.99
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: Cigna of CA HMO |
$632.96
|
| Rate for Payer: Cigna of CA PPO |
$731.86
|
| 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 |
$692.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.01
|
| 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 |
$405.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$593.40
|
| 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
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903200190
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$197.80 |
| Max. Negotiated Rate |
$890.10 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$692.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: EPIC Health Plan Senior |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903200190
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$405.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.99
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: Cigna of CA HMO |
$632.96
|
| Rate for Payer: Cigna of CA PPO |
$731.86
|
| 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 |
$692.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.01
|
| 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 |
$405.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$593.40
|
| 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
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903208876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$197.80 |
| Max. Negotiated Rate |
$890.10 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Central Health Plan Commercial |
$791.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$692.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: EPIC Health Plan Senior |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$890.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
|
