|
HC SKULL LIMITED
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.69 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.89
|
| Rate for Payer: Blue Shield of California Commercial |
$738.99
|
| Rate for Payer: Blue Shield of California EPN |
$465.68
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
IP
|
$32.06
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Adventist Health Commercial |
$6.41
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Central Health Plan Commercial |
$25.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: EPIC Health Plan Senior |
$12.82
|
| Rate for Payer: Galaxy Health WC |
$27.25
|
| Rate for Payer: Global Benefits Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$20.84
|
| Rate for Payer: Prime Health Services Commercial |
$27.25
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
OP
|
$32.06
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Adventist Health Commercial |
$6.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.65
|
| Rate for Payer: Blue Shield of California Commercial |
$20.33
|
| Rate for Payer: Blue Shield of California EPN |
$12.79
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Central Health Plan Commercial |
$25.65
|
| Rate for Payer: Cigna of CA HMO |
$20.52
|
| Rate for Payer: Cigna of CA PPO |
$23.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: EPIC Health Plan Senior |
$12.82
|
| Rate for Payer: Galaxy Health WC |
$27.25
|
| Rate for Payer: Global Benefits Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.44
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$20.84
|
| Rate for Payer: Prime Health Services Commercial |
$27.25
|
| Rate for Payer: Riverside University Health System MISP |
$12.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.03
|
| Rate for Payer: United Healthcare All Other HMO |
$16.03
|
| Rate for Payer: United Healthcare HMO Rider |
$16.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.25
|
| Rate for Payer: Vantage Medical Group Senior |
$27.25
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$3,531.60 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,139.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,531.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,315.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.80
|
| Rate for Payer: Multiplan Commercial |
$2,943.00
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$363.42 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,639.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,352.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,557.83
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,139.20
|
| Rate for Payer: Cigna of CA HMO |
$2,511.36
|
| Rate for Payer: Cigna of CA PPO |
$2,903.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,531.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$2,943.00
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,354.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,327.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC SLEEP STUDY UA RCRDG HR OS RA AND ST
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
903600050
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$609.30 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Central Health Plan Commercial |
$541.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$473.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.80
|
| Rate for Payer: EPIC Health Plan Senior |
$270.80
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$609.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$429.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$399.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.40
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
|
|
HC SLEEP STUDY UA RCRDG HR OS RA AND ST
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
903600050
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$959.38 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$959.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$932.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.81
|
| Rate for Payer: Blue Shield of California Commercial |
$426.51
|
| Rate for Payer: Blue Shield of California EPN |
$268.77
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Central Health Plan Commercial |
$541.60
|
| Rate for Payer: Cigna of CA HMO |
$433.28
|
| Rate for Payer: Cigna of CA PPO |
$500.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$473.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$609.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$236.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$429.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC SLEEP STUDY UNATTENDEDD
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
903600036
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$331.60 |
| Max. Negotiated Rate |
$1,492.20 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,326.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$663.20
|
| Rate for Payer: EPIC Health Plan Senior |
$663.20
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,492.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$978.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.60
|
| Rate for Payer: Multiplan Commercial |
$1,243.50
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
|
|
HC SLEEP STUDY UNATTENDEDD
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
903600036
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$142.28 |
| Max. Negotiated Rate |
$1,492.20 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$773.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,129.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$964.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,044.54
|
| Rate for Payer: Blue Shield of California EPN |
$658.23
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,326.40
|
| Rate for Payer: Cigna of CA HMO |
$1,061.12
|
| Rate for Payer: Cigna of CA PPO |
$1,226.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,492.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,243.50
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$373.11 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.29
|
| Rate for Payer: Blue Shield of California Commercial |
$491.40
|
| Rate for Payer: Blue Shield of California Commercial |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$309.66
|
| Rate for Payer: Blue Shield of California EPN |
$76.22
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA HMO |
$122.88
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Cigna of CA PPO |
$142.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC SLING ARM LG DELUXE WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
|
|
HC SLING ARM LG DELUXE WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$15.79 |
| 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 |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$15.79 |
| 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 |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
|
IP
|
$40.75
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Adventist Health Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California Commercial |
$32.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Central Health Plan Commercial |
$32.60
|
| Rate for Payer: Cigna of CA HMO |
$28.52
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.30
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$34.64
|
| Rate for Payer: Global Benefits Group Commercial |
$24.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$30.56
|
| Rate for Payer: Networks By Design Commercial |
$26.49
|
| Rate for Payer: Prime Health Services Commercial |
$34.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.35
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
|
OP
|
$40.75
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Adventist Health Commercial |
$16.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.70
|
| Rate for Payer: Blue Shield of California Commercial |
$32.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Central Health Plan Commercial |
$32.60
|
| Rate for Payer: Cigna of CA HMO |
$28.52
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.30
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$34.64
|
| Rate for Payer: Global Benefits Group Commercial |
$24.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$30.56
|
| Rate for Payer: Networks By Design Commercial |
$20.38
|
| Rate for Payer: Prime Health Services Commercial |
$34.64
|
| Rate for Payer: Riverside University Health System MISP |
$16.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Vantage Medical Group Senior |
$34.64
|
|
|
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 |
$5.75 |
| Max. Negotiated Rate |
$15.79 |
| 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 |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.02
|
| 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 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 |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| 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 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 |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| 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 |
$7.41 |
| Max. Negotiated Rate |
$20.37 |
| 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 |
$13.16
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$11.31
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Riverside University Health System MISP |
$9.05
|
| 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 DEEP POCKET ARM LRG
|
Facility
|
OP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.40 |
| Max. Negotiated Rate |
$1,309.19 |
| 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 |
$846.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.64
|
| Rate for Payer: Blue Shield of California EPN |
$733.15
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,309.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$528.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,018.26
|
| Rate for Payer: Multiplan Commercial |
$1,090.99
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: Riverside University Health System MISP |
$581.86
|
| 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 |
$1,309.19 |
| Rate for Payer: Adventist Health Commercial |
$290.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.64
|
| Rate for Payer: Blue Shield of California EPN |
$733.15
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.73
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,309.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.93
|
| Rate for Payer: Multiplan Commercial |
$1,090.99
|
| Rate for Payer: Networks By Design Commercial |
$945.53
|
| 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
|
OP
|
$25.75
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.98
|
| Rate for Payer: Blue Shield of California Commercial |
$20.65
|
| Rate for Payer: Blue Shield of California EPN |
$12.98
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Central Health Plan Commercial |
$20.60
|
| Rate for Payer: Cigna of CA HMO |
$18.02
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Senior |
$10.30
|
| Rate for Payer: Galaxy Health WC |
$21.89
|
| Rate for Payer: Global Benefits Group Commercial |
$15.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.02
|
| Rate for Payer: Multiplan Commercial |
$19.31
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.89
|
| Rate for Payer: Riverside University Health System MISP |
$10.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.89
|
| Rate for Payer: Vantage Medical Group Senior |
$21.89
|
|
