|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Cigna of CA HMO |
$1,406.08
|
| Rate for Payer: Cigna of CA PPO |
$1,625.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,465.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$1,757.60
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,098.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,098.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,098.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,098.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$722.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.82
|
| Rate for Payer: Blue Shield of California Commercial |
$674.42
|
| Rate for Payer: Blue Shield of California EPN |
$445.21
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cigna of CA HMO |
$705.28
|
| Rate for Payer: Cigna of CA PPO |
$815.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
|
|
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 |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$504.90
|
| Rate for Payer: Blue Shield of California EPN |
$333.30
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$453.75
|
| 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 Permanente of CA Commercial/Self Funded |
$550.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.68
|
| 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 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 |
$33.03
|
| Rate for Payer: Cash Price |
$29.58
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.30
|
| 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 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 |
$29.58
|
| 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 Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.30
|
| 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 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 |
$3,335.40 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,573.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,409.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2,401.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,585.30
|
| Rate for Payer: Cash Price |
$2,158.20
|
| Rate for Payer: Cash Price |
$2,158.20
|
| Rate for Payer: Cash Price |
$2,158.20
|
| 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 |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| 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 |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| 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 |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
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 |
$2,158.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| 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 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 |
$429.00
|
| 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 Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| 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 SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.25
|
| Rate for Payer: Blue Shield of California Commercial |
$521.82
|
| Rate for Payer: Blue Shield of California EPN |
$344.76
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| 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 HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
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 |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 |
$8.78
|
| 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 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 |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 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 |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 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 |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 |
$8.78
|
| 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 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 |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cigna of CA HMO |
$28.59
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| 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 |
$20.42
|
| 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 |
$23.65
|
| Rate for Payer: Blue Shield of California Commercial |
$30.14
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.46
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| 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 PEDIATRIC X-SMALL
|
Facility
|
OP
|
$32.31
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698142
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$27.46 |
| Rate for Payer: Adventist Health Commercial |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.71
|
| Rate for Payer: Blue Shield of California Commercial |
$23.84
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cigna of CA HMO |
$22.62
|
| Rate for Payer: Cigna of CA PPO |
$22.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$25.85
|
| Rate for Payer: Networks By Design Commercial |
$16.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.46
|
| Rate for Payer: Vantage Medical Group Senior |
$27.46
|
|
|
HC SLING ARM PEDIATRIC X-SMALL
|
Facility
|
IP
|
$32.31
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698142
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cigna of CA HMO |
$22.62
|
| Rate for Payer: Cigna of CA PPO |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$25.85
|
| Rate for Payer: Networks By Design Commercial |
$16.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
|
|
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 |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 |
$8.78
|
| 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 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 |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| 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 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 |
$13.11
|
| Rate for Payer: Blue Shield of California Commercial |
$16.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$12.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| 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 |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| 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 |
$11.31
|
| 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 ARM XSMALL
|
Facility
|
OP
|
$18.61
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698124
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.04
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cigna of CA HMO |
$13.03
|
| Rate for Payer: Cigna of CA PPO |
$13.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC SLING ARM XSMALL
|
Facility
|
IP
|
$18.61
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698124
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cigna of CA HMO |
$13.03
|
| Rate for Payer: Cigna of CA PPO |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
|
