|
HC STRAPPING OF SHOULDER MCAL
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901300013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$824.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Senior |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$748.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$695.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC STRAPPING OF TOES
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900419073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$599.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.04
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC STRAPPING OF TOES
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900419073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC STRAPPING OF TOES
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC STRAPPING OF TOES
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC STRAPPING OF TOES
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| 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 |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$731.00
|
| Rate for Payer: United Healthcare All Other HMO |
$731.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$731.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC STRAPPING OF TOES
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$599.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC STRAPPING SHOULDER
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901301208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$824.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Senior |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$748.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$695.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC STRAPPING SHOULDER
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901301208
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$482.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$824.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$748.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.34
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC STRAPPING THORAX
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
902890345
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$349.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$223.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Central Health Plan Commercial |
$682.40
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$767.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$639.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC STRAPPING THORAX
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
902890345
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$767.70 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Central Health Plan Commercial |
$682.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$767.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.60
|
| Rate for Payer: Multiplan Commercial |
$639.75
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.59 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$209.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$561.72
|
| Rate for Payer: Blue Shield of California EPN |
$353.51
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Cigna of CA HMO |
$567.04
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| 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 |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Cigna of CA HMO |
$567.04
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$363.26
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Cigna of CA HMO |
$567.04
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$209.00
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Prime Health Services Medicare |
$221.54
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$229.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
900501109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$797.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$562.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.20
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
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 |
$291.94 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Cash Price |
$145.97
|
| Rate for Payer: Central Health Plan Commercial |
$259.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.07
|
| 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: Health Management Network EPO/PPO |
$291.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: Multiplan Commercial |
$243.28
|
| Rate for Payer: Networks By Design Commercial |
$210.85
|
| Rate for Payer: Prime Health Services Commercial |
$275.72
|
|
|
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 |
$291.94 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.00
|
| 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 Exchange |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.69
|
| Rate for Payer: Blue Shield of California Commercial |
$205.66
|
| Rate for Payer: Blue Shield of California EPN |
$129.43
|
| Rate for Payer: Cash Price |
$145.97
|
| Rate for Payer: Central Health Plan Commercial |
$259.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.07
|
| 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: Health Management Network EPO/PPO |
$291.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$227.07
|
| Rate for Payer: Multiplan Commercial |
$243.28
|
| Rate for Payer: Networks By Design Commercial |
$210.85
|
| Rate for Payer: Prime Health Services Commercial |
$275.72
|
| Rate for Payer: Riverside University Health System MISP |
$129.75
|
| 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 LG
|
Facility
|
OP
|
$162.12
|
|
| Hospital Charge Code |
901605684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.31
|
| Rate for Payer: Blue Shield of California Commercial |
$102.78
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Riverside University Health System MISP |
$64.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC STRAP SURGI-BRA NYLON LG
|
Facility
|
IP
|
$162.12
|
|
| Hospital Charge Code |
901605684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
|
HC STRAP SURGI-BRA NYLON MED
|
Facility
|
OP
|
$162.12
|
|
| Hospital Charge Code |
901605685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.31
|
| Rate for Payer: Blue Shield of California Commercial |
$102.78
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Riverside University Health System MISP |
$64.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC STRAP SURGI-BRA NYLON MED
|
Facility
|
IP
|
$162.12
|
|
| Hospital Charge Code |
901605685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
|
HC STRAP SURGI-BRA X-LARGE
|
Facility
|
OP
|
$162.12
|
|
| Hospital Charge Code |
901603298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.31
|
| Rate for Payer: Blue Shield of California Commercial |
$102.78
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Riverside University Health System MISP |
$64.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC STRAP SURGI-BRA X-LARGE
|
Facility
|
IP
|
$162.12
|
|
| Hospital Charge Code |
901603298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
