|
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
|
|
|
HC APP OF LONG ARM SPLINT MCARE COM
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
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 MCARE COM
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
901300087
|
|
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 PT
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
903200186
|
|
Hospital Revenue Code
|
420
|
| 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 PT
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
903200186
|
|
Hospital Revenue Code
|
420
|
| 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 LEG CAST BRACE
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.40 |
| 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 |
$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 |
$655.20
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: Cigna of CA PPO |
$808.08
|
| 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 |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$819.00
|
| 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 |
$728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| 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 |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
| 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 |
$655.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.00
|
| Rate for Payer: United Healthcare All Other HMO |
$546.00
|
| Rate for Payer: United Healthcare HMO Rider |
$546.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.00
|
| 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 APP OF LONG LEG CAST BRACE
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
900501688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.80
|
| Rate for Payer: Galaxy Health WC |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
|
|
HC APP OF SHORT ARM CAST
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.28
|
| 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 |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.40
|
| Rate for Payer: Blue Shield of California EPN |
$462.10
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| 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 |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| 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 |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| 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 |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| 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 |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$472.50
|
| Rate for Payer: United Healthcare HMO Rider |
$472.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.50
|
| 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 SHORT ARM CAST
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.04 |
| 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 |
$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 |
$567.00
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| 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 |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| 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 |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| 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 |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| 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 |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$472.50
|
| Rate for Payer: United Healthcare HMO Rider |
$472.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.50
|
| 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 SHORT ARM CAST
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC APP OF SHORT ARM CAST
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
900501400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.85
|
| 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 |
$745.80
|
| Rate for Payer: Blue Shield of California Commercial |
$781.85
|
| Rate for Payer: Blue Shield of California EPN |
$607.83
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.50
|
| Rate for Payer: United Healthcare All Other HMO |
$621.50
|
| Rate for Payer: United Healthcare HMO Rider |
$621.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.50
|
| 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 SHORT ARM SPLINT
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.85
|
| 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 |
$745.80
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.63
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| 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 SHORT ARM SPLINT
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
903200187
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$745.80
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.50
|
| Rate for Payer: United Healthcare All Other HMO |
$621.50
|
| Rate for Payer: United Healthcare HMO Rider |
$621.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.50
|
| 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 SHORT ARM SPLINT
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
903200187
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.85
|
| 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 |
$745.80
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.63
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| 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 SHORT ARM SPLINT MCAL
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.85
|
| 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 |
$745.80
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.63
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| 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 SHORT ARM SPLINT MCARE COMM
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.85
|
| 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 |
$745.80
|
| 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 |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| 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 |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| 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 |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.63
|
| 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 |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| 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 |
$745.80
|
| 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 ON BODY INJECTOR
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
901796377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
|
|
HC APP ON BODY INJECTOR
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
901796377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.31
|
| Rate for Payer: Blue Distinction Transplant |
$58.20
|
| Rate for Payer: Blue Shield of California Commercial |
$61.01
|
| Rate for Payer: Blue Shield of California EPN |
$47.43
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.50
|
| Rate for Payer: United Healthcare All Other HMO |
$48.50
|
| Rate for Payer: United Healthcare HMO Rider |
$48.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
