|
HC SHIGATOXIN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$295.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.84
|
| Rate for Payer: Blue Shield of California Commercial |
$386.74
|
| Rate for Payer: Blue Shield of California EPN |
$243.39
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Riverside University Health System MISP |
$244.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.25
|
| Rate for Payer: Blue Shield of California EPN |
$92.67
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Riverside University Health System MISP |
$92.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.25
|
| Rate for Payer: Blue Shield of California EPN |
$92.67
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Riverside University Health System MISP |
$92.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.25
|
| Rate for Payer: Blue Shield of California EPN |
$92.67
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Riverside University Health System MISP |
$92.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.25
|
| Rate for Payer: Blue Shield of California EPN |
$92.67
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Riverside University Health System MISP |
$92.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PEDS FLEX LONG 5.0 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.25
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| Rate for Payer: Blue Shield of California EPN |
$162.74
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Riverside University Health System MISP |
$163.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.0 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.5 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.25
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| Rate for Payer: Blue Shield of California EPN |
$162.74
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Riverside University Health System MISP |
$163.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 5.5 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 6.0 CUFF
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC SHILEY PEDS FLEX LONG 6.0 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.25
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| Rate for Payer: Blue Shield of California EPN |
$162.74
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Riverside University Health System MISP |
$163.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS X-LONG 5.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 6.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
