|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.00 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.00
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,594.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,407.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,139.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,917.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,883.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,376.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.11
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: Cigna of CA HMO |
$2,489.60
|
| Rate for Payer: Cigna of CA PPO |
$2,878.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,306.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,306.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.00
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1,945.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,594.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,407.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,723.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,723.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,556.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,334.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,945.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,945.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,945.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,306.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,306.50
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$161.91
|
| Rate for Payer: Blue Shield of California EPN |
$105.73
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,568.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Adventist Health Commercial |
$313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$952.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$951.78
|
| Rate for Payer: Blue Shield of California EPN |
$622.50
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.40
|
| Rate for Payer: Cigna of CA HMO |
$1,003.52
|
| Rate for Payer: Cigna of CA PPO |
$1,160.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,332.80
|
| Rate for Payer: Global Benefits Group Commercial |
$940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,176.00
|
| Rate for Payer: Networks By Design Commercial |
$1,019.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.80
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$940.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$1,568.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Adventist Health Commercial |
$313.60
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$627.20
|
| Rate for Payer: Galaxy Health WC |
$1,332.80
|
| Rate for Payer: Global Benefits Group Commercial |
$940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$970.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$1,176.00
|
| Rate for Payer: Networks By Design Commercial |
$1,019.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.80
|
|
|
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 |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| 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 Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| 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 |
$26.26 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$712.01
|
| Rate for Payer: Blue Shield of California EPN |
$465.68
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$18.83
|
| Rate for Payer: Blue Shield of California Commercial |
$19.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.79
|
| Rate for Payer: Cash Price |
$17.63
|
| 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: 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: InnovAge PACE Commercial |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.44
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$17.63
|
| Rate for Payer: Central Health Plan Commercial |
$25.65
|
| 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 Permanente of CA Commercial/Self Funded |
$21.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.85
|
| 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 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 |
$3,531.60 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,383.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,352.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,381.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,557.83
|
| Rate for Payer: Cash Price |
$2,158.20
|
| Rate for Payer: Cash Price |
$2,158.20
|
| Rate for Payer: Cash Price |
$2,158.20
|
| 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 |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| 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 |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| 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 |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| 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 |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
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 |
$2,158.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,139.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| 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 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 |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,129.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$973.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.41
|
| Rate for Payer: Blue Shield of California EPN |
$658.23
|
| Rate for Payer: Cash Price |
$911.90
|
| Rate for Payer: Cash Price |
$911.90
|
| Rate for Payer: Cash Price |
$911.90
|
| 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 |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| 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 |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| 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 |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| 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 |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
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 |
$911.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,326.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,105.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,026.30
|
| 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 SLIDE PREP/REFERRED MATERIAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$116.54
|
| Rate for Payer: Blue Shield of California EPN |
$76.22
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$122.88
|
| Rate for Payer: Cigna of CA PPO |
$142.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| 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 HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
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 |
$10.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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: InnovAge PACE Commercial |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$10.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$9.65
|
| 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: 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: InnovAge PACE Commercial |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$23.93
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$22.41
|
| 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: 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: InnovAge PACE Commercial |
$20.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.52
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$22.41
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.22
|
| 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 X-SMALL
|
Facility
|
OP
|
$32.31
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698142
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.98
|
| Rate for Payer: Blue Shield of California Commercial |
$24.98
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$22.62
|
| Rate for Payer: Cigna of CA PPO |
$22.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: InnovAge PACE Commercial |
$16.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$16.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Riverside University Health System MISP |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.46
|
| Rate for Payer: Vantage Medical Group Senior |
$27.46
|
|
|
HC SLING ARM PEDIATRIC X-SMALL
|
Facility
|
IP
|
$32.31
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698142
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$24.98
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$22.62
|
| Rate for Payer: Cigna of CA PPO |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
|
