|
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 |
$1,060.20 |
| Rate for Payer: Adventist Health Commercial |
$482.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$715.40
|
| 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 Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$647.90
|
| Rate for Payer: Cash Price |
$647.90
|
| Rate for Payer: Cash Price |
$647.90
|
| Rate for Payer: Cash Price |
$647.90
|
| 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 |
$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 |
$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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| 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 |
$482.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| 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 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 |
$647.90
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| 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 Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$729.18
|
| 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 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 |
$1,833.00 |
| 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 |
$518.03
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.97
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| 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 |
$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 |
$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 |
$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: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| 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 |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$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 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 |
$469.15
|
| Rate for Payer: Central Health Plan Commercial |
$682.40
|
| 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 Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| 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
|
450
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| 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 Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$548.43
|
| 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
|
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 |
$487.30
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| 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 Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$548.43
|
| 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 |
$1,833.00 |
| 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 |
$538.07
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.35
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| 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 |
$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 |
$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 |
$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: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| 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 |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| 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 |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$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 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 |
$797.40 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$538.07
|
| 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 Exchange |
$429.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.35
|
| Rate for Payer: Blue Shield of California Commercial |
$541.35
|
| Rate for Payer: Blue Shield of California EPN |
$353.51
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| 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 |
$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 |
$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 |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| 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 |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$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 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 |
$2,696.00 |
| 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 |
$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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| 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 |
$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 |
$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 |
$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: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| 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 |
$177.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| 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 |
$200.49
|
| 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 |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| 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 |
$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 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 |
$487.30
|
| Rate for Payer: Central Health Plan Commercial |
$708.80
|
| 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 Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$548.43
|
| 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 |
$178.41
|
| Rate for Payer: Central Health Plan Commercial |
$259.50
|
| 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 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 |
$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 |
$190.51
|
| Rate for Payer: Blue Shield of California Commercial |
$198.20
|
| Rate for Payer: Blue Shield of California EPN |
$129.43
|
| Rate for Payer: Cash Price |
$178.41
|
| 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: 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: InnovAge PACE Commercial |
$162.19
|
| 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 |
$64.88
|
| 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 |
$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 |
$95.21
|
| Rate for Payer: Blue Shield of California Commercial |
$99.06
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$89.17
|
| 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: 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: InnovAge PACE Commercial |
$81.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA 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 |
$89.17
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| 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 Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| 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
|
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 |
$89.17
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| 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 Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| 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 |
$95.21
|
| Rate for Payer: Blue Shield of California Commercial |
$99.06
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$89.17
|
| 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: 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: InnovAge PACE Commercial |
$81.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA 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 |
$89.17
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| 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 Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| 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 |
$95.21
|
| Rate for Payer: Blue Shield of California Commercial |
$99.06
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$89.17
|
| 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: 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: InnovAge PACE Commercial |
$81.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA 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 STREPTOCARD STREP A
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
900912483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC STREPTOCARD STREP A
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
900912483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$13.96
|
| Rate for Payer: Blue Shield of California EPN |
$9.13
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.32
|
| Rate for Payer: EPIC Health Plan Senior |
$16.53
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.53
|
| Rate for Payer: InnovAge PACE Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.15
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.53
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Medicare |
$17.52
|
| Rate for Payer: Riverside University Health System MISP |
$18.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.18
|
| Rate for Payer: Vantage Medical Group Senior |
$16.53
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.07
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.07
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.07
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
