|
HC SKULL LIMITED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$577.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$330.00
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$486.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.59
|
| Rate for Payer: Blue Shield of California Commercial |
$347.32
|
| Rate for Payer: Blue Shield of California Commercial |
$526.35
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cigna of CA HMO |
$528.00
|
| Rate for Payer: Cigna of CA PPO |
$610.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$577.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
IP
|
$53.79
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
OP
|
$53.79
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.52
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cigna of CA HMO |
$34.43
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26.89
|
| Rate for Payer: United Healthcare HMO Rider |
$26.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.72
|
| Rate for Payer: Vantage Medical Group Senior |
$45.72
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$354.97 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,990.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,518.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,652.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,503.51
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cigna of CA HMO |
$2,511.36
|
| Rate for Payer: Cigna of CA PPO |
$2,903.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,354.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,327.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,315.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
|
|
HC SLEEP STUDY UA RCRDG HR OS RA AND ST
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
903600050
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$575.45 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$473.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.80
|
| Rate for Payer: EPIC Health Plan Senior |
$270.80
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$429.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$399.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.48
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
|
|
HC SLEEP STUDY UA RCRDG HR OS RA AND ST
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
903600050
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$1,087.05 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,087.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.43
|
| Rate for Payer: Blue Shield of California Commercial |
$285.02
|
| Rate for Payer: Blue Shield of California Commercial |
$431.93
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cigna of CA HMO |
$433.28
|
| Rate for Payer: Cigna of CA PPO |
$500.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$473.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$429.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$422.76 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.08
|
| Rate for Payer: Blue Shield of California Commercial |
$359.58
|
| Rate for Payer: Blue Shield of California Commercial |
$133.82
|
| Rate for Payer: Blue Shield of California Commercial |
$543.66
|
| Rate for Payer: Blue Shield of California Commercial |
$88.51
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA HMO |
$122.88
|
| Rate for Payer: Cigna of CA PPO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC SLING ARM LG DELUXE WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.62
|
| Rate for Payer: Blue Shield of California Commercial |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM LG DELUXE WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.62
|
| Rate for Payer: Blue Shield of California Commercial |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
|
IP
|
$40.84
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$28.59
|
| Rate for Payer: Cigna of CA PPO |
$28.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Senior |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$32.67
|
| Rate for Payer: Networks By Design Commercial |
$26.55
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.33
|
| Rate for Payer: United Healthcare All Other HMO |
$14.92
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
|
OP
|
$40.84
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$34.71 |
| Rate for Payer: Adventist Health Commercial |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.72
|
| Rate for Payer: Blue Shield of California Commercial |
$20.71
|
| Rate for Payer: Blue Shield of California Commercial |
$31.41
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$28.59
|
| Rate for Payer: Cigna of CA PPO |
$28.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Senior |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$32.67
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.33
|
| Rate for Payer: United Healthcare All Other HMO |
$14.92
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.71
|
| Rate for Payer: Vantage Medical Group Senior |
$34.71
|
|
|
HC SLING ARM SMALL WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.62
|
| Rate for Payer: Blue Shield of California Commercial |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM SMALL WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
|
|
HC SLING ARM XLG
|
Facility
|
OP
|
$22.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$11.31
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.49
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC SLING ARM XLG
|
Facility
|
IP
|
$22.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.49
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
OP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.12 |
| Max. Negotiated Rate |
$1,236.46 |
| Rate for Payer: Adventist Health Commercial |
$596.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,090.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$880.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,118.63
|
| Rate for Payer: Blue Shield of California Commercial |
$737.51
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$528.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.26
|
| Rate for Payer: Multiplan Commercial |
$1,163.73
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$872.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$872.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.46
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
IP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.93 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: Adventist Health Commercial |
$290.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.12
|
| Rate for Payer: Multiplan Commercial |
$1,163.73
|
| Rate for Payer: Networks By Design Commercial |
$945.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cigna of CA HMO |
$17.68
|
| Rate for Payer: Cigna of CA PPO |
$17.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.27
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$10.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.29
|
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$19.42
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cigna of CA HMO |
$17.68
|
| Rate for Payer: Cigna of CA PPO |
$17.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$182.41
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
