|
HC APHERESIS W SEL ABS FILT REINF ADULT
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
CPT 36516
|
| Hospital Charge Code |
945003651
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2,601.80 |
| Max. Negotiated Rate |
$11,708.10 |
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,203.60
|
| Rate for Payer: Galaxy Health WC |
$11,057.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,708.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,956.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,601.80
|
| Rate for Payer: Multiplan Commercial |
$9,756.75
|
| Rate for Payer: Networks By Design Commercial |
$8,455.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,057.65
|
|
|
HC APHERESIS W SEL ABS FILT REINF ADULT
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
CPT 36516
|
| Hospital Charge Code |
945003651
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$11,708.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,782.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,805.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,182.66
|
| Rate for Payer: Blue Shield of California EPN |
$6,361.40
|
| Rate for Payer: Caremore Medicare Advantage |
$5,782.14
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,407.20
|
| Rate for Payer: Cigna of CA HMO |
$8,325.76
|
| Rate for Payer: Cigna of CA PPO |
$9,626.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$11,057.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,708.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,756.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,540.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: InnovAge PACE Commercial |
$8,673.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,601.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,748.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$9,756.75
|
| Rate for Payer: Networks By Design Commercial |
$8,455.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,057.65
|
| Rate for Payer: Prime Health Services Medicare |
$6,129.07
|
| Rate for Payer: Riverside University Health System MISP |
$6,360.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,805.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,805.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC APHERESIS W SEL ABS FILT REINF PEDS
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
CPT 36516
|
| Hospital Charge Code |
945036516
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$11,708.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,782.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,805.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,182.66
|
| Rate for Payer: Blue Shield of California EPN |
$6,361.40
|
| Rate for Payer: Caremore Medicare Advantage |
$5,782.14
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,407.20
|
| Rate for Payer: Cigna of CA HMO |
$8,325.76
|
| Rate for Payer: Cigna of CA PPO |
$9,626.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$11,057.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,708.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,756.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,540.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: InnovAge PACE Commercial |
$8,673.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,601.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,748.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$9,756.75
|
| Rate for Payer: Networks By Design Commercial |
$8,455.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,057.65
|
| Rate for Payer: Prime Health Services Medicare |
$6,129.07
|
| Rate for Payer: Riverside University Health System MISP |
$6,360.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,805.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,805.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC APHERESIS W SEL ABS FILT REINF PEDS
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
CPT 36516
|
| Hospital Charge Code |
945036516
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2,601.80 |
| Max. Negotiated Rate |
$11,708.10 |
| Rate for Payer: Cash Price |
$5,854.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,203.60
|
| Rate for Payer: Galaxy Health WC |
$11,057.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,708.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,956.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,601.80
|
| Rate for Payer: Multiplan Commercial |
$9,756.75
|
| Rate for Payer: Networks By Design Commercial |
$8,455.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,057.65
|
|
|
HC APLS IGA
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC APLS IGA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APLS IGG
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC APLS IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$186.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.14
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Media |
$25.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: InnovAge PACE Commercial |
$38.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC APLS IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APLS IGM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$939.60 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$626.40
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: Cigna of CA PPO |
$772.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: InnovAge PACE Commercial |
$503.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
| Rate for Payer: Prime Health Services Medicare |
$355.68
|
| Rate for Payer: Riverside University Health System MISP |
$369.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$626.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other HMO |
$522.00
|
| Rate for Payer: United Healthcare HMO Rider |
$522.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APPL COMP ASST EQUIP GT 30 MIM PT
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97620
|
| Hospital Charge Code |
905103209
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC APPL COMP ASST EQUIP GT 30 MIM PT
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97620
|
| Hospital Charge Code |
905103209
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC APPL COMP ASST EQUIP GT 30MIN OT
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97620
|
| Hospital Charge Code |
905104209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC APPL COMP ASST EQUIP GT 30MIN OT
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97620
|
| Hospital Charge Code |
905104209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC APPLICATION HAND WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: InnovAge PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Riverside University Health System MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION HAND WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: InnovAge PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Riverside University Health System MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$625.86
|
| Rate for Payer: Blue Shield of California EPN |
$486.56
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: InnovAge PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Riverside University Health System MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: InnovAge PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Riverside University Health System MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: InnovAge PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Riverside University Health System MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
