|
HC SHILEY PEDS X-LONG 5.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: 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 6.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: 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 6.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: 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 6.5 UNCUFF
|
Facility
|
OP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$298.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.94
|
| Rate for Payer: Blue Distinction Transplant |
$199.00
|
| Rate for Payer: Blue Shield of California Commercial |
$208.61
|
| Rate for Payer: Blue Shield of California EPN |
$162.18
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Central Health Plan Commercial |
$265.33
|
| Rate for Payer: Cigna of CA HMO |
$212.26
|
| Rate for Payer: Cigna of CA PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.91
|
| Rate for Payer: Dignity Health Media |
$281.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$248.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.33
|
| Rate for Payer: Multiplan Commercial |
$248.74
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
| Rate for Payer: Riverside University Health System MISP |
$132.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.83
|
| Rate for Payer: United Healthcare All Other HMO |
$165.83
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.91
|
| Rate for Payer: Vantage Medical Group Senior |
$281.91
|
|
|
HC SHILEY PEDS X-LONG 6.5 UNCUFF
|
Facility
|
IP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$298.49 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Central Health Plan Commercial |
$265.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.33
|
| Rate for Payer: Multiplan Commercial |
$248.74
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.09
|
| Rate for Payer: Blue Shield of California EPN |
$102.69
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Media |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
OP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$177.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.75
|
| Rate for Payer: Blue Distinction Transplant |
$118.57
|
| Rate for Payer: Blue Shield of California Commercial |
$124.30
|
| Rate for Payer: Blue Shield of California EPN |
$96.63
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Central Health Plan Commercial |
$158.09
|
| Rate for Payer: Cigna of CA HMO |
$126.47
|
| Rate for Payer: Cigna of CA PPO |
$146.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.97
|
| Rate for Payer: Dignity Health Media |
$167.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.04
|
| Rate for Payer: Galaxy Health WC |
$167.97
|
| Rate for Payer: Global Benefits Group Commercial |
$118.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$148.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.52
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: Networks By Design Commercial |
$128.45
|
| Rate for Payer: Prime Health Services Commercial |
$167.97
|
| Rate for Payer: Riverside University Health System MISP |
$79.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.80
|
| Rate for Payer: United Healthcare All Other HMO |
$98.80
|
| Rate for Payer: United Healthcare HMO Rider |
$98.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.97
|
| Rate for Payer: Vantage Medical Group Senior |
$167.97
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
IP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$177.85 |
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Central Health Plan Commercial |
$158.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.04
|
| Rate for Payer: Galaxy Health WC |
$167.97
|
| Rate for Payer: Global Benefits Group Commercial |
$118.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.52
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: Networks By Design Commercial |
$128.45
|
| Rate for Payer: Prime Health Services Commercial |
$167.97
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.62
|
| Rate for Payer: Blue Distinction Transplant |
$124.53
|
| Rate for Payer: Blue Shield of California Commercial |
$130.55
|
| Rate for Payer: Blue Shield of California EPN |
$101.49
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Media |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$155.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.62
|
| Rate for Payer: Blue Distinction Transplant |
$124.53
|
| Rate for Payer: Blue Shield of California Commercial |
$130.55
|
| Rate for Payer: Blue Shield of California EPN |
$101.49
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Media |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$155.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.62
|
| Rate for Payer: Blue Distinction Transplant |
$124.53
|
| Rate for Payer: Blue Shield of California Commercial |
$130.55
|
| Rate for Payer: Blue Shield of California EPN |
$101.49
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Media |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$155.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.09
|
| Rate for Payer: Blue Shield of California EPN |
$102.69
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Media |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.27
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.64
|
| Rate for Payer: Blue Shield of California EPN |
$17.60
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Media |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
IP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$365.29 |
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Central Health Plan Commercial |
$324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$345.00
|
| Rate for Payer: Global Benefits Group Commercial |
$243.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: Networks By Design Commercial |
$263.82
|
| Rate for Payer: Prime Health Services Commercial |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
OP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$365.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.79
|
| Rate for Payer: Blue Distinction Transplant |
$243.53
|
| Rate for Payer: Blue Shield of California Commercial |
$255.30
|
| Rate for Payer: Blue Shield of California EPN |
$198.48
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Central Health Plan Commercial |
$324.70
|
| Rate for Payer: Cigna of CA HMO |
$259.76
|
| Rate for Payer: Cigna of CA PPO |
$300.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.00
|
| Rate for Payer: Dignity Health Media |
$345.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$345.00
|
| Rate for Payer: Global Benefits Group Commercial |
$243.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$304.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: Networks By Design Commercial |
$263.82
|
| Rate for Payer: Prime Health Services Commercial |
$345.00
|
| Rate for Payer: Riverside University Health System MISP |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.94
|
| Rate for Payer: United Healthcare All Other HMO |
$202.94
|
| Rate for Payer: United Healthcare HMO Rider |
$202.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.00
|
| Rate for Payer: Vantage Medical Group Senior |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
OP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.10
|
| Rate for Payer: Blue Distinction Transplant |
$232.67
|
| Rate for Payer: Blue Shield of California Commercial |
$243.91
|
| Rate for Payer: Blue Shield of California EPN |
$189.62
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Central Health Plan Commercial |
$310.22
|
| Rate for Payer: Cigna of CA HMO |
$248.18
|
| Rate for Payer: Cigna of CA PPO |
$286.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.61
|
| Rate for Payer: Dignity Health Media |
$329.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$155.11
|
| Rate for Payer: Galaxy Health WC |
$329.61
|
| Rate for Payer: Global Benefits Group Commercial |
$232.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$290.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.56
|
| Rate for Payer: Multiplan Commercial |
$290.84
|
| Rate for Payer: Networks By Design Commercial |
$252.06
|
| Rate for Payer: Prime Health Services Commercial |
$329.61
|
| Rate for Payer: Riverside University Health System MISP |
$155.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.89
|
| Rate for Payer: United Healthcare All Other HMO |
$193.89
|
| Rate for Payer: United Healthcare HMO Rider |
$193.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$329.61
|
| Rate for Payer: Vantage Medical Group Senior |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
IP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Central Health Plan Commercial |
$310.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.11
|
| Rate for Payer: Galaxy Health WC |
$329.61
|
| Rate for Payer: Global Benefits Group Commercial |
$232.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.56
|
| Rate for Payer: Multiplan Commercial |
$290.84
|
| Rate for Payer: Networks By Design Commercial |
$252.06
|
| Rate for Payer: Prime Health Services Commercial |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.07
|
| Rate for Payer: Blue Distinction Transplant |
$226.55
|
| Rate for Payer: Blue Shield of California Commercial |
$237.50
|
| Rate for Payer: Blue Shield of California EPN |
$184.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Media |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$283.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
