|
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 |
$4,132.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,011.20
|
| 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 Permanente of CA Commercial/Self Funded |
$5,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,862.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,651.17
|
| 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 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$4,132.70
|
| Rate for Payer: Cash Price |
$4,132.70
|
| Rate for Payer: Cash Price |
$4,132.70
|
| Rate for Payer: Cash Price |
$4,132.70
|
| 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 |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| 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 |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| 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 |
$1,882.11
|
| 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 |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| 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 |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
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 |
$1,833.00 |
| 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 |
$764.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$739.41
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| 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 |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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 |
$2,696.00 |
| 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 |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| 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 |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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 |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$755.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$755.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$755.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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 |
$1,133.10 |
| Rate for Payer: Adventist Health Commercial |
$516.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| 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 |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| 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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$755.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.59
|
| 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 |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
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 |
$692.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,007.20
|
| 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 Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.32
|
| 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 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 |
$2,696.00 |
| 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 |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$794.20
|
| Rate for Payer: Cash Price |
$794.20
|
| Rate for Payer: Cash Price |
$794.20
|
| Rate for Payer: Cash Price |
$794.20
|
| 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 |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| 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 |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$963.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| 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 |
$337.45
|
| 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 |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| 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 |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
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 |
$794.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,155.20
|
| 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 Permanente of CA Commercial/Self Funded |
$963.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.84
|
| 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
|
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 |
$568.15
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| 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 Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$639.43
|
| 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
|
456
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$1,833.00 |
| 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 |
$627.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.68
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| 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 |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| 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 |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| 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 |
$337.45
|
| 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 |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| 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 |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
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 |
$2,696.00 |
| 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 |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| 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 |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| 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 |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| 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 |
$337.45
|
| 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 |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| 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 |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
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 |
$568.15
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| 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 Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$639.43
|
| 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
|
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 |
$903.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,017.02
|
| 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 |
$1,833.00 |
| 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 |
$997.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$964.93
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| 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 |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
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 |
$903.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,017.02
|
| 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 |
903200187
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Adventist Health Commercial |
$673.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$997.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$985.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.54
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
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 |
$2,696.00 |
| 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 |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| 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 |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
