|
HC APPLICATION HAND WRIST CAST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$228.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC APP LONG LEG CAST
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$217.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$199.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.99 |
| Max. Negotiated Rate |
$2,005.50 |
| Rate for Payer: Adventist Health Commercial |
$534.80
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$483.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.50
|
| Rate for Payer: Multiplan Commercial |
$2,005.50
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,617.28 |
| Rate for Payer: Adventist Health Commercial |
$534.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,837.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,738.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,275.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$483.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$2,005.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$962.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$885.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$519.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$667.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$463.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$349.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$728.25 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903208876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Senior |
$195.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903208876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Adventist Health Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.93
|
| Rate for Payer: Heritage Provider Network Senior |
$213.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Senior |
$195.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
901300011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Adventist Health Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.93
|
| Rate for Payer: Heritage Provider Network Senior |
$213.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.89
|
| Rate for Payer: Heritage Provider Network Senior |
$178.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC APP OF FINGER SPLINT-STATIC
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
903208875
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
|
|
HC APP OF FINGER SPLINT-STATIC MCAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
901300009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.89
|
| Rate for Payer: Heritage Provider Network Senior |
$178.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC APP OF HIP SPICA CAST
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
900501404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
