|
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 |
$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
|
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
|
|
|
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 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 |
$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 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 |
$1,478.70 |
| 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: 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 |
$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 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 |
$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 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 |
$1,478.70 |
| 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: 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 |
$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 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 |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| 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 Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| 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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$55.60
|
| Rate for Payer: Blue Shield of California EPN |
$36.31
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| 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 |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| 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 |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| 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 |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| 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 |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903200188
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$384.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.65
|
| 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 |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: Cigna of CA HMO |
$600.32
|
| Rate for Payer: Cigna of CA PPO |
$694.12
|
| 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 |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| 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 |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.58
|
| 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 |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
| 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 |
$562.80
|
| 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 SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903200188
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$187.60
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$375.20
|
| Rate for Payer: Galaxy Health WC |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$580.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$187.60
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$375.20
|
| Rate for Payer: Galaxy Health WC |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$580.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$384.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.65
|
| 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 |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: Cigna of CA HMO |
$600.32
|
| Rate for Payer: Cigna of CA PPO |
$694.12
|
| 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 |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| 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 |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.58
|
| 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 |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
| 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 |
$562.80
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$384.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.65
|
| 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 |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: Cigna of CA HMO |
$600.32
|
| Rate for Payer: Cigna of CA PPO |
$694.12
|
| 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 |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| 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 |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.58
|
| 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 |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
| 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 |
$562.80
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Adventist Health Commercial |
$187.60
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Central Health Plan Commercial |
$750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$375.20
|
| Rate for Payer: Galaxy Health WC |
$797.30
|
| Rate for Payer: Global Benefits Group Commercial |
$562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$844.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$625.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$580.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$703.50
|
| Rate for Payer: Networks By Design Commercial |
$609.70
|
| Rate for Payer: Prime Health Services Commercial |
$797.30
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$582.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.37
|
| 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 |
$833.97
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| 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 |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| 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 |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| 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 |
$1,065.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| 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 |
$1,207.00
|
| 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 |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SHORT LEG CAST
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| 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 |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| 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 |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| 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 |
$1,065.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| 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 |
$1,207.00
|
| 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 |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.00
|
| Rate for Payer: United Healthcare All Other HMO |
$710.00
|
| Rate for Payer: United Healthcare HMO Rider |
$710.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.00
|
| 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 SHORT LEG CAST
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,598.40 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$710.40
|
| Rate for Payer: EPIC Health Plan Senior |
$710.40
|
| Rate for Payer: Galaxy Health WC |
$1,509.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,065.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,598.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,184.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,099.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
| Rate for Payer: Networks By Design Commercial |
$1,154.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,509.60
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,598.40 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$710.40
|
| Rate for Payer: EPIC Health Plan Senior |
$710.40
|
| Rate for Payer: Galaxy Health WC |
$1,509.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,065.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,598.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,184.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,099.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
| Rate for Payer: Networks By Design Commercial |
$1,154.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,509.60
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,420.80
|
| Rate for Payer: Cigna of CA HMO |
$1,136.64
|
| Rate for Payer: Cigna of CA PPO |
$1,314.24
|
| 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 |
$1,509.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,065.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,598.40
|
| 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 |
$1,184.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| 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 |
$1,332.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,154.40
|
| 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 |
$1,509.60
|
| 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 |
$1,065.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Other HMO |
$888.00
|
| Rate for Payer: United Healthcare HMO Rider |
$888.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$888.00
|
| 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 SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$728.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,078.56
|
| 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 |
$1,043.04
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,420.80
|
| Rate for Payer: Cigna of CA HMO |
$1,136.64
|
| Rate for Payer: Cigna of CA PPO |
$1,314.24
|
| 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 |
$1,509.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,065.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,598.40
|
| 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 |
$1,184.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| 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 |
$1,332.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$1,154.40
|
| 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 |
$1,509.60
|
| 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 |
$1,065.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,065.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SHORT LEG SPLINT
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,083.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$717.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,063.38
|
| 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 |
$1,028.36
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: Cigna of CA HMO |
$1,120.64
|
| Rate for Payer: Cigna of CA PPO |
$1,295.74
|
| 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 |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| 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 |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| 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 |
$1,313.25
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| 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 |
$1,488.35
|
| 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 |
$1,050.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,050.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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
|
|
