|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Central Health Plan Commercial |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.20
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$673.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.60
|
| Rate for Payer: Multiplan Commercial |
$561.00
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| 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 |
$448.80
|
| 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 |
$76.42
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Central Health Plan Commercial |
$598.40
|
| Rate for Payer: Cigna of CA HMO |
$478.72
|
| Rate for Payer: Cigna of CA PPO |
$553.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$673.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$561.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$561.00
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.70
|
| 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 |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903200189
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$710.40
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: Cigna of CA HMO |
$757.76
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.52
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$710.40
|
| Rate for Payer: Blue Shield of California Commercial |
$744.74
|
| Rate for Payer: Blue Shield of California EPN |
$578.98
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: Cigna of CA HMO |
$757.76
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$710.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.00
|
| Rate for Payer: United Healthcare All Other HMO |
$592.00
|
| Rate for Payer: United Healthcare HMO Rider |
$592.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$710.40
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: Cigna of CA HMO |
$757.76
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.52
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| 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 |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$710.40
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.00
|
| Rate for Payer: United Healthcare All Other HMO |
$592.00
|
| Rate for Payer: United Healthcare HMO Rider |
$592.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903200189
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$710.40
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: Cigna of CA HMO |
$757.76
|
| Rate for Payer: Cigna of CA PPO |
$876.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$888.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$710.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.52
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Central Health Plan Commercial |
$947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Galaxy Health WC |
$1,006.40
|
| Rate for Payer: Global Benefits Group Commercial |
$710.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$769.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,006.40
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$612.60
|
| Rate for Payer: Blue Shield of California Commercial |
$642.21
|
| Rate for Payer: Blue Shield of California EPN |
$499.27
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA HMO |
$653.44
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| 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 |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$553.66
|
| 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 |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| 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 |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| 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 |
$612.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| 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 APP OF HIP SPICA CAST
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$612.60
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| 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 |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| 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 |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| 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 |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| 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 |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| 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 APP OF INTERDENTAL FIXATION
|
Facility
|
IP
|
$5,682.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,136.40 |
| Max. Negotiated Rate |
$5,113.80 |
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,272.80
|
| Rate for Payer: Galaxy Health WC |
$4,829.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,113.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,164.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.40
|
| Rate for Payer: Multiplan Commercial |
$4,261.50
|
| Rate for Payer: Networks By Design Commercial |
$3,693.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,829.70
|
|
|
HC APP OF INTERDENTAL FIXATION
|
Facility
|
OP
|
$5,682.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
900501575
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$5,779.00 |
| 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 |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,409.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,545.60
|
| Rate for Payer: Cigna of CA PPO |
$4,204.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$4,829.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,113.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,261.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$4,261.50
|
| Rate for Payer: Networks By Design Commercial |
$3,693.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,829.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$571.20
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| 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 |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| 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 |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| 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 |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| 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 |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other HMO |
$476.00
|
| Rate for Payer: United Healthcare HMO Rider |
$476.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.00
|
| 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 APP OF LONG ARM SPLINT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.90
|
| 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 |
$571.20
|
| Rate for Payer: Blue Shield of California Commercial |
$598.81
|
| Rate for Payer: Blue Shield of California EPN |
$465.53
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| 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 |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| 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 |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| 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 |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| 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 |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other HMO |
$476.00
|
| Rate for Payer: United Healthcare HMO Rider |
$476.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.00
|
| 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 APP OF LONG ARM SPLINT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
900501100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.90
|
| 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 |
$571.20
|
| 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 |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| 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 |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| 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 |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.32
|
| 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 |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| 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 |
$571.20
|
| 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 APP OF LONG ARM SPLINT MCAL
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.90
|
| 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 |
$571.20
|
| 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 |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| 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 |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| 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 |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.32
|
| 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 |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| 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 |
$571.20
|
| 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
|
|
