|
HC SHEATH SET/30-80CM
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.80
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC SHIGATOXIN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SHIGATOXIN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.70
|
| Rate for Payer: Blue Shield of California Commercial |
$66.23
|
| Rate for Payer: Blue Shield of California EPN |
$43.76
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.60
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PEDS FLEX LONG 5.0 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.0 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.5 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.5 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 6.0 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 6.0 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS X-LONG 5.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
