|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903200188
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.50
|
| 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 |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$454.40
|
| Rate for Payer: Cigna of CA PPO |
$525.40
|
| 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 |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$532.50
|
| 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 |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| 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 |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| 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 |
$426.00
|
| 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 SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903200188
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.50
|
| 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 |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$454.40
|
| Rate for Payer: Cigna of CA PPO |
$525.40
|
| 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 |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$532.50
|
| 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 |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| 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 |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| 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 |
$426.00
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.50
|
| 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 |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$454.40
|
| Rate for Payer: Cigna of CA PPO |
$525.40
|
| 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 |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$532.50
|
| 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 |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| 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 |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| 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 |
$426.00
|
| 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 SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.71
|
| 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 |
$644.40
|
| Rate for Payer: Blue Shield of California Commercial |
$675.55
|
| Rate for Payer: Blue Shield of California EPN |
$525.19
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA HMO |
$687.36
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| 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 |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| 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 |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| 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 |
$644.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$537.00
|
| Rate for Payer: United Healthcare HMO Rider |
$537.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$537.00
|
| 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 SHORT LEG CAST
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$644.40
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| 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 |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| 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 |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| 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 |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$537.00
|
| Rate for Payer: United Healthcare HMO Rider |
$537.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$537.00
|
| 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 SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$268.60 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.20
|
| Rate for Payer: Galaxy Health WC |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,208.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.60
|
| Rate for Payer: Multiplan Commercial |
$1,007.25
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$268.60 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.20
|
| Rate for Payer: Galaxy Health WC |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,208.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.60
|
| Rate for Payer: Multiplan Commercial |
$1,007.25
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.81
|
| 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 |
$805.80
|
| Rate for Payer: Blue Shield of California Commercial |
$844.75
|
| Rate for Payer: Blue Shield of California EPN |
$656.73
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,074.40
|
| Rate for Payer: Cigna of CA HMO |
$859.52
|
| Rate for Payer: Cigna of CA PPO |
$993.82
|
| 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 |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,208.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,007.25
|
| 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 |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.60
|
| 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 |
$1,007.25
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
| 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 |
$805.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$805.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$671.50
|
| Rate for Payer: United Healthcare HMO Rider |
$671.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$671.50
|
| 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 SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$805.80
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,074.40
|
| Rate for Payer: Cigna of CA PPO |
$993.82
|
| 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 |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,208.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,007.25
|
| 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 |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.60
|
| 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 |
$1,007.25
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
| 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 |
$805.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$671.50
|
| Rate for Payer: United Healthcare HMO Rider |
$671.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$671.50
|
| 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 SHORT LEG SPLINT
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,191.60 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| 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 |
$794.40
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| 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 |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$993.00
|
| 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 |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| 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 |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| 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 |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| 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 SHORT LEG SPLINT
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.74
|
| 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 |
$794.40
|
| Rate for Payer: Blue Shield of California Commercial |
$832.80
|
| Rate for Payer: Blue Shield of California EPN |
$647.44
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: Cigna of CA HMO |
$847.36
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| 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 |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$993.00
|
| 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 |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| 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 |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| 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 |
$794.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| 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 SHORT LEG SPLINT
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,191.60 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,073.20 |
| Max. Negotiated Rate |
$4,829.40 |
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,292.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,146.40
|
| Rate for Payer: Galaxy Health WC |
$4,561.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,829.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,579.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,044.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.20
|
| Rate for Payer: Multiplan Commercial |
$4,024.50
|
| Rate for Payer: Networks By Design Commercial |
$3,487.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,561.10
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.18 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$3,219.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,292.80
|
| Rate for Payer: Cigna of CA PPO |
$3,970.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,561.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,829.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,024.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,579.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,024.50
|
| Rate for Payer: Networks By Design Commercial |
$3,487.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,561.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Multiplan Commercial |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.34
|
| 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 |
$267.60
|
| 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 |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: Cigna of CA HMO |
$285.44
|
| Rate for Payer: Cigna of CA PPO |
$330.04
|
| 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 |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$334.50
|
| 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 |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.86
|
| 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 |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| 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 |
$267.60
|
| 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 VENOUS WOUND COMP SYS KNEE
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.34
|
| 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 |
$267.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: Cigna of CA PPO |
$330.04
|
| 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 |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$334.50
|
| 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 |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| 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 |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| 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 |
$267.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 VENOUS WOUND COMP SYS KNEE
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Multiplan Commercial |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$61.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.70
|
| Rate for Payer: Dignity Health Media |
$86.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$76.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.82
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Riverside University Health System MISP |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.70
|
| Rate for Payer: Vantage Medical Group Senior |
$86.70
|
|
