|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
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
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
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-STATIC
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| 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 |
$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 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 |
$260.96
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| 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 |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| 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 |
$994.41
|
| 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 |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.00
|
| Rate for Payer: United Healthcare All Other HMO |
$783.00
|
| Rate for Payer: United Healthcare HMO Rider |
$783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$783.00
|
| 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
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903200189
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$642.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| 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 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 |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| 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 |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| 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 |
$642.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| 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
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903200189
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$642.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| 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 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 |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| 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 |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| 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 |
$642.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| 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
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$642.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| 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 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 |
$260.96
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| 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 |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| 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 |
$994.41
|
| 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 |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.60
|
| 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 MCAL
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$642.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| 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 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 |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| 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 |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| 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 |
$642.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| 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
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| 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 |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| 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 |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| 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 |
$857.25
|
| 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 |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| 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 |
$1,147.50
|
| 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 |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO |
$675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$675.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.00
|
| 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
|
$1,350.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$553.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,005.70
|
| 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 |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| 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 |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| 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 |
$857.25
|
| 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 |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| 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 |
$1,147.50
|
| 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 |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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
|
$1,350.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC APP OF INTERDENTAL FIXATION
|
Facility
|
OP
|
$7,514.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$6,762.60 |
| Rate for Payer: Adventist Health Commercial |
$1,502.80
|
| 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 |
$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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,011.20
|
| Rate for Payer: Cigna of CA HMO |
$4,808.96
|
| Rate for Payer: Cigna of CA PPO |
$5,560.36
|
| 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 |
$5,259.80
|
| 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 |
$6,386.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,762.60
|
| 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 |
$4,771.39
|
| 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 |
$1,502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$5,635.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,884.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,386.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,757.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,757.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,757.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,757.00
|
| 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 INTERDENTAL FIXATION
|
Facility
|
IP
|
$7,514.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,502.80 |
| Max. Negotiated Rate |
$6,762.60 |
| Rate for Payer: Adventist Health Commercial |
$1,502.80
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,011.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,005.60
|
| Rate for Payer: Galaxy Health WC |
$6,386.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,762.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,433.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.80
|
| Rate for Payer: Multiplan Commercial |
$5,635.50
|
| Rate for Payer: Networks By Design Commercial |
$4,884.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,386.90
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$251.80 |
| Max. Negotiated Rate |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: EPIC Health Plan Senior |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$742.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$209.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.43
|
| 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 |
$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 |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Cigna of CA HMO |
$805.76
|
| Rate for Payer: Cigna of CA PPO |
$931.66
|
| 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 |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$799.47
|
| 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 |
$516.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$755.40
|
| 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
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$251.80 |
| Max. Negotiated Rate |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: EPIC Health Plan Senior |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$742.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| 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 |
$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 |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Cigna of CA HMO |
$805.76
|
| Rate for Payer: Cigna of CA PPO |
$931.66
|
| 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 |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| 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 |
$799.47
|
| 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 |
$251.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| 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 |
$1,070.15
|
| 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 |
$755.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$629.50
|
| Rate for Payer: United Healthcare HMO Rider |
$629.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.50
|
| 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
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.43
|
| 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 |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Cigna of CA HMO |
$805.76
|
| Rate for Payer: Cigna of CA PPO |
$931.66
|
| 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 |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| 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 |
$799.47
|
| 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 |
$251.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| 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 |
$1,070.15
|
| 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 |
$755.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$755.40
|
| 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
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.80 |
| Max. Negotiated Rate |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: EPIC Health Plan Senior |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$742.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
|
HC APP OF LONG ARM SPLINT MCAL
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$251.80 |
| Max. Negotiated Rate |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: EPIC Health Plan Senior |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,133.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$742.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
