|
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
|
|
|
HC APP OF LONG ARM SPLINT MCARE COM
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
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 MCARE COM
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
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 PT
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
903200186
|
|
Hospital Revenue Code
|
420
|
| 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 PT
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
903200186
|
|
Hospital Revenue Code
|
420
|
| 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 LEG CAST BRACE
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.37 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$288.80
|
| 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 |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,155.20
|
| Rate for Payer: Cigna of CA HMO |
$924.16
|
| Rate for Payer: Cigna of CA PPO |
$1,068.56
|
| 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 |
$1,010.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$1,227.40
|
| Rate for Payer: Global Benefits Group Commercial |
$866.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,299.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$916.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$281.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$938.60
|
| 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 |
$1,227.40
|
| 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 |
$866.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$722.00
|
| Rate for Payer: United Healthcare All Other HMO |
$722.00
|
| Rate for Payer: United Healthcare HMO Rider |
$722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$722.00
|
| 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 LONG LEG CAST BRACE
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.80 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Adventist Health Commercial |
$288.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,010.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$577.60
|
| Rate for Payer: Galaxy Health WC |
$1,227.40
|
| Rate for Payer: Global Benefits Group Commercial |
$866.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,299.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$916.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$851.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
| Rate for Payer: Networks By Design Commercial |
$938.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,227.40
|
|
|
HC APP OF SHORT ARM CAST
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$423.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.92
|
| 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 |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| 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 |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| 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 |
$878.05
|
| 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 |
$619.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP OF SHORT ARM CAST
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$206.60 |
| Max. Negotiated Rate |
$929.70 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Senior |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC APP OF SHORT ARM CAST
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| 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 |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| 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 |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| 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 |
$878.05
|
| 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 |
$619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.50
|
| Rate for Payer: United Healthcare All Other HMO |
$516.50
|
| Rate for Payer: United Healthcare HMO Rider |
$516.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.50
|
| 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 SHORT ARM CAST
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.60 |
| Max. Negotiated Rate |
$929.70 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Senior |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.48
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| 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 |
$985.80
|
| 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 SHORT ARM SPLINT
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
903200187
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.48
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| 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 |
$985.80
|
| 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 SHORT ARM SPLINT
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| 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 |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| 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 |
$1,396.55
|
| 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 |
$985.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$821.50
|
| Rate for Payer: United Healthcare All Other HMO |
$821.50
|
| Rate for Payer: United Healthcare HMO Rider |
$821.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$821.50
|
| 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 SHORT ARM SPLINT
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.48
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| 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 |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| 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 |
$1,396.55
|
| 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 |
$985.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$985.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SHORT ARM SPLINT
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
903200187
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.48
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| 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 |
$985.80
|
| 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 SHORT ARM SPLINT MCARE COMM
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.48
|
| 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 |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,051.52
|
| Rate for Payer: Cigna of CA PPO |
$1,215.82
|
| 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 |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$1,067.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| 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 |
$985.80
|
| 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 ON BODY INJECTOR
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
901796377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
|
|
HC APP ON BODY INJECTOR
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
901796377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$125.97 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.93
|
| Rate for Payer: Blue Shield of California Commercial |
$57.69
|
| Rate for Payer: Blue Shield of California EPN |
$36.31
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$58.24
|
| Rate for Payer: Cigna of CA PPO |
$67.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.50
|
| Rate for Payer: United Healthcare All Other HMO |
$45.50
|
| Rate for Payer: United Healthcare HMO Rider |
$45.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
