|
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 |
$149.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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 |
$149.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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 5.5
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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 |
$149.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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 6.5
|
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: United Healthcare HMO Rider |
$116.13
|
| 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 |
$149.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| 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
|
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 |
$134.18
|
| 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 |
$261.72
|
| Rate for Payer: Cash Price |
$183.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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 5.0 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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 5.5 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 |
$134.18
|
| 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 |
$261.72
|
| Rate for Payer: Cash Price |
$183.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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 |
$134.18
|
| 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 |
$261.72
|
| Rate for Payer: Cash Price |
$183.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 5.0 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 |
$135.36
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$135.36
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 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: Galaxy Health WC |
$297.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$135.36
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 6.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 6.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
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 |
$135.36
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 SCT 10.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.76
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
IP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$167.97 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.04
|
| Rate for Payer: EPIC Health Plan Senior |
$79.04
|
| Rate for Payer: Galaxy Health WC |
$167.97
|
| Rate for Payer: Global Benefits Group Commercial |
$118.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.43
|
| Rate for Payer: Multiplan Commercial |
$158.09
|
| Rate for Payer: Networks By Design Commercial |
$128.45
|
| Rate for Payer: Prime Health Services Commercial |
$167.97
|
|
