|
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 |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| 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 |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: 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 |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.92
|
| Rate for Payer: 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
|
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 |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: 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 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 |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: 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 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 |
$8.37
|
| 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 |
$8.37
|
| Rate for Payer: Cash Price |
$8.37
|
| 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
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
OP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.12 |
| Max. Negotiated Rate |
$1,236.46 |
| Rate for Payer: Adventist Health Commercial |
$596.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,090.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$842.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.54
|
| Rate for Payer: Blue Shield of California EPN |
$706.96
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.26
|
| Rate for Payer: Multiplan Commercial |
$1,163.73
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$872.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$872.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.46
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
IP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.93 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$290.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.12
|
| Rate for Payer: Multiplan Commercial |
$1,163.73
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cigna of CA HMO |
$17.68
|
| Rate for Payer: Cigna of CA PPO |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.27
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$10.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.63
|
| Rate for Payer: Blue Shield of California Commercial |
$18.64
|
| Rate for Payer: Blue Shield of California EPN |
$12.28
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cigna of CA HMO |
$17.68
|
| Rate for Payer: Cigna of CA PPO |
$17.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.54
|
| Rate for Payer: Blue Shield of California Commercial |
$207.10
|
| Rate for Payer: Blue Shield of California EPN |
$136.39
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
IP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.02
|
| Rate for Payer: Multiplan Commercial |
$226.74
|
| Rate for Payer: Networks By Design Commercial |
$141.72
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
OP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$240.92 |
| Rate for Payer: Adventist Health Commercial |
$116.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.16
|
| Rate for Payer: Blue Shield of California Commercial |
$209.17
|
| Rate for Payer: Blue Shield of California EPN |
$137.75
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$226.74
|
| Rate for Payer: Networks By Design Commercial |
$141.72
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.92
|
| Rate for Payer: Vantage Medical Group Senior |
$240.92
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.54
|
| Rate for Payer: Blue Shield of California Commercial |
$207.10
|
| Rate for Payer: Blue Shield of California EPN |
$136.39
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,675.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA HMO |
$5,361.92
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,675.60 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Adventist Health Commercial |
$1,675.60
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$23,711.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,742.20 |
| Max. Negotiated Rate |
$20,154.35 |
| Rate for Payer: Adventist Health Commercial |
$4,742.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17,498.72
|
| Rate for Payer: Blue Shield of California EPN |
$11,523.55
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,484.40
|
| Rate for Payer: Galaxy Health WC |
$20,154.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,226.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,815.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,033.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,677.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.64
|
| Rate for Payer: Multiplan Commercial |
$18,968.80
|
| Rate for Payer: Networks By Design Commercial |
$15,412.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,154.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,898.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,661.63
|
| Rate for Payer: United Healthcare HMO Rider |
$8,474.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,765.35
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$23,711.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,314.91 |
| Max. Negotiated Rate |
$30,945.95 |
| Rate for Payer: Adventist Health Commercial |
$4,742.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,552.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,746.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,560.93
|
| Rate for Payer: Blue Shield of California Commercial |
$14,511.13
|
| Rate for Payer: Blue Shield of California EPN |
$9,579.24
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: Cigna of CA HMO |
$15,175.04
|
| Rate for Payer: Cigna of CA PPO |
$17,546.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,746.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,825.13
|
| Rate for Payer: EPIC Health Plan Senior |
$4,314.91
|
| Rate for Payer: Galaxy Health WC |
$20,154.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,226.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,076.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,362.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,314.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,815.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,945.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,314.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,781.98
|
| Rate for Payer: Multiplan Commercial |
$18,968.80
|
| Rate for Payer: Networks By Design Commercial |
$15,412.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,154.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,226.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,226.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,898.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,661.63
|
| Rate for Payer: United Healthcare HMO Rider |
$8,474.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,765.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,314.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,746.40
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.96 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,144.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.94
|
| Rate for Payer: Blue Shield of California EPN |
$704.98
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: EPIC Health Plan Senior |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
