|
HC STRAPPING KNEE
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
900501108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cigna of CA HMO |
$462.72
|
| Rate for Payer: Cigna of CA PPO |
$535.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$614.55
|
| Rate for Payer: Global Benefits Group Commercial |
$433.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| 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/Self Funded |
$482.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$469.95
|
| Rate for Payer: Prime Health Services Commercial |
$614.55
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$433.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$361.50
|
| Rate for Payer: United Healthcare All Other HMO |
$361.50
|
| Rate for Payer: United Healthcare HMO Rider |
$361.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| 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 STRAPPING OF ELBOW OR WRIST
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
900501428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC STRAPPING OF ELBOW OR WRIST
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
900501428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$378.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| 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 STRAPPING OF ELBOW OR WRIST MCAL
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901300015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC STRAPPING OF ELBOW OR WRIST MCAL
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901300015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.63
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna of CA HMO |
$556.80
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| 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 STRAPPING OF HAND OR FINGER MCAL
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901300017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: EPIC Health Plan Senior |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$635.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
|
|
HC STRAPPING OF HAND OR FINGER MCAL
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901300017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$420.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$672.95
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO |
$656.64
|
| Rate for Payer: Cigna of CA PPO |
$759.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| 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 STRAPPING OF SHOULDER
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
900501103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| 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/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$378.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| 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 STRAPPING OF SHOULDER
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
900501103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC STRAPPING OF SHOULDER MCAL
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901300013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.63
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna of CA HMO |
$556.80
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| 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 STRAPPING OF SHOULDER MCAL
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901300013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC STRAPPING OF TOES
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC STRAPPING OF TOES
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna of CA HMO |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO |
$540.00
|
| Rate for Payer: United Healthcare HMO Rider |
$540.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$540.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| 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 STRAPPING SHOULDER
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901301208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC STRAPPING SHOULDER
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901301208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.63
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna of CA HMO |
$556.80
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| 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 STRAPPING UNNA BOOT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$490.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| 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/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| 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 STRAP SURGI-BRA NYLON 2XL
|
Facility
|
OP
|
$324.38
|
|
| Hospital Charge Code |
901605686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$275.72 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.20
|
| Rate for Payer: Cash Price |
$145.97
|
| Rate for Payer: Cigna of CA HMO |
$207.60
|
| Rate for Payer: Cigna of CA PPO |
$240.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.75
|
| Rate for Payer: EPIC Health Plan Senior |
$129.75
|
| Rate for Payer: Galaxy Health WC |
$275.72
|
| Rate for Payer: Global Benefits Group Commercial |
$194.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.07
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$210.85
|
| Rate for Payer: Prime Health Services Commercial |
$275.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.19
|
| Rate for Payer: United Healthcare All Other HMO |
$162.19
|
| Rate for Payer: United Healthcare HMO Rider |
$162.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.72
|
| Rate for Payer: Vantage Medical Group Senior |
$275.72
|
|
|
HC STRAP SURGI-BRA NYLON 2XL
|
Facility
|
IP
|
$324.38
|
|
| Hospital Charge Code |
901605686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$275.72 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Cash Price |
$145.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.75
|
| Rate for Payer: EPIC Health Plan Senior |
$129.75
|
| Rate for Payer: Galaxy Health WC |
$275.72
|
| Rate for Payer: Global Benefits Group Commercial |
$194.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$210.85
|
| Rate for Payer: Prime Health Services Commercial |
$275.72
|
|
|
HC STRAP SURGI-BRA NYLON LG
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901605684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC STRAP SURGI-BRA NYLON LG
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901605684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.77
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC STRAP SURGI-BRA NYLON MED
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901605685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC STRAP SURGI-BRA NYLON MED
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901605685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.77
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC STRAP SURGI-BRA X-LARGE
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901603298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC STRAP SURGI-BRA X-LARGE
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901603298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.77
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
