|
HC SHEATH SET/11CM (COOK)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.90
|
| Rate for Payer: Blue Distinction Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.48
|
| Rate for Payer: Blue Shield of California EPN |
$58.68
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Media |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SHEATH SET/30-80CM
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.06
|
| Rate for Payer: Blue Distinction Transplant |
$152.40
|
| Rate for Payer: Blue Shield of California Commercial |
$159.77
|
| Rate for Payer: Blue Shield of California EPN |
$124.21
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Media |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$190.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Riverside University Health System MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC SHEATH SET/30-80CM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC SHIGATOXIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$82.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.38
|
| Rate for Payer: Blue Distinction Transplant |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.36
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SHIGATOXIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
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: 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 |
$335.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$295.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.39
|
| Rate for Payer: Blue Distinction Transplant |
$366.00
|
| Rate for Payer: Blue Shield of California Commercial |
$383.69
|
| Rate for Payer: Blue Shield of California EPN |
$298.29
|
| 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 Media |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$457.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$213.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| 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
|
| 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 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: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| 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
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| 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 |
$127.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.22
|
| Rate for Payer: Blue Distinction Transplant |
$139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$146.09
|
| Rate for Payer: Blue Shield of California EPN |
$113.58
|
| 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 Media |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$174.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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 Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$209.03 |
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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: 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 |
$127.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.22
|
| Rate for Payer: Blue Distinction Transplant |
$139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$146.09
|
| Rate for Payer: Blue Shield of California EPN |
$113.58
|
| 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 Media |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$174.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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 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: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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: 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 |
$127.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.22
|
| Rate for Payer: Blue Distinction Transplant |
$139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$146.09
|
| Rate for Payer: Blue Shield of California EPN |
$113.58
|
| 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 Media |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$174.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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 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: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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: 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 |
$127.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.22
|
| Rate for Payer: Blue Distinction Transplant |
$139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$146.09
|
| Rate for Payer: Blue Shield of California EPN |
$113.58
|
| 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 Media |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$174.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| 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 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: Cash Price |
$104.52
|
| Rate for Payer: Central Health Plan Commercial |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.45
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PEDS FLEX LONG 5.0 CUFF
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$224.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.96
|
| Rate for Payer: Blue Distinction Transplant |
$244.72
|
| Rate for Payer: Blue Shield of California Commercial |
$256.54
|
| Rate for Payer: Blue Shield of California EPN |
$199.44
|
| 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 Media |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$305.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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 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: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$224.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.96
|
| Rate for Payer: Blue Distinction Transplant |
$244.72
|
| Rate for Payer: Blue Shield of California Commercial |
$256.54
|
| Rate for Payer: Blue Shield of California EPN |
$199.44
|
| 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 Media |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$305.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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 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: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$224.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.96
|
| Rate for Payer: Blue Distinction Transplant |
$244.72
|
| Rate for Payer: Blue Shield of California Commercial |
$256.54
|
| Rate for Payer: Blue Shield of California EPN |
$199.44
|
| 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 Media |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$305.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.90
|
| 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 Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC SHILEY PEDS X-LONG 5.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| 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 5.0 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: Aetna of CA HMO/PPO |
$124.68
|
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| 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 Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| 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
|
| 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| 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
|
|
