|
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 |
$18.34
|
| Rate for Payer: Central Health Plan Commercial |
$32.60
|
| Rate for Payer: Cigna of CA HMO |
$28.52
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: 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
|
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 |
$14.54
|
| 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
|
|
|
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 |
$14.54
|
| 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 SMALL WITH PAD
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.31
|
| 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 |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.92
|
| Rate for Payer: 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 SMALL WITH PAD
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$12.29
|
| Rate for Payer: 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 XLG
|
Facility
|
OP
|
$22.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.49
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: InnovAge PACE Commercial |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$11.31
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Riverside University Health System MISP |
$9.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.49
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC SLING ARM XLG
|
Facility
|
IP
|
$22.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.49
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$15.84
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.49
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
|
|
HC SLING ARM XSMALL
|
Facility
|
OP
|
$18.61
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698124
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.93
|
| Rate for Payer: Blue Shield of California Commercial |
$14.39
|
| Rate for Payer: Blue Shield of California EPN |
$9.38
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: Cigna of CA HMO |
$13.03
|
| Rate for Payer: Cigna of CA PPO |
$13.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: InnovAge PACE Commercial |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: Riverside University Health System MISP |
$7.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC SLING ARM XSMALL
|
Facility
|
IP
|
$18.61
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698124
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.39
|
| Rate for Payer: Blue Shield of California EPN |
$9.38
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: Cigna of CA HMO |
$13.03
|
| Rate for Payer: Cigna of CA PPO |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
IP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.93 |
| Max. Negotiated Rate |
$1,309.19 |
| Rate for Payer: Adventist Health Commercial |
$290.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,124.45
|
| Rate for Payer: Blue Shield of California EPN |
$733.15
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.73
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.93
|
| Rate for Payer: Multiplan Commercial |
$1,090.99
|
| Rate for Payer: Networks By Design Commercial |
$945.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
|
|
HC SLING DEEP POCKET ARM LRG
|
Facility
|
OP
|
$1,454.66
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.40 |
| Max. Negotiated Rate |
$1,309.19 |
| Rate for Payer: Adventist Health Commercial |
$596.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,090.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$854.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,124.45
|
| Rate for Payer: Blue Shield of California EPN |
$733.15
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.73
|
| Rate for Payer: Cigna of CA HMO |
$1,018.26
|
| Rate for Payer: Cigna of CA PPO |
$1,018.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Senior |
$581.86
|
| Rate for Payer: Galaxy Health WC |
$1,236.46
|
| Rate for Payer: Global Benefits Group Commercial |
$872.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.19
|
| Rate for Payer: InnovAge PACE Commercial |
$727.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.26
|
| Rate for Payer: Multiplan Commercial |
$1,090.99
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
| Rate for Payer: Riverside University Health System MISP |
$581.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$872.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$872.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.93
|
| Rate for Payer: United Healthcare All Other HMO |
$531.39
|
| Rate for Payer: United Healthcare HMO Rider |
$519.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.46
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
IP
|
$25.75
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Adventist Health Commercial |
$5.15
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$12.98
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Central Health Plan Commercial |
$20.60
|
| Rate for Payer: Cigna of CA HMO |
$18.02
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Senior |
$10.30
|
| Rate for Payer: Galaxy Health WC |
$21.89
|
| Rate for Payer: Global Benefits Group Commercial |
$15.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$19.31
|
| Rate for Payer: Networks By Design Commercial |
$16.74
|
| Rate for Payer: Prime Health Services Commercial |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.43
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
|
OP
|
$25.75
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.12
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$12.98
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Central Health Plan Commercial |
$20.60
|
| Rate for Payer: Cigna of CA HMO |
$18.02
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Senior |
$10.30
|
| Rate for Payer: Galaxy Health WC |
$21.89
|
| Rate for Payer: Global Benefits Group Commercial |
$15.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.18
|
| Rate for Payer: InnovAge PACE Commercial |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.02
|
| Rate for Payer: Multiplan Commercial |
$19.31
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.89
|
| Rate for Payer: Riverside University Health System MISP |
$10.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.89
|
| Rate for Payer: Vantage Medical Group Senior |
$21.89
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.91 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.81
|
| Rate for Payer: Blue Shield of California Commercial |
$216.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Central Health Plan Commercial |
$224.50
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.57
|
| Rate for Payer: InnovAge PACE Commercial |
$140.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Riverside University Health System MISP |
$112.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Blue Shield of California Commercial |
$216.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Central Health Plan Commercial |
$224.50
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.13
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$182.41
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
OP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$255.09 |
| Rate for Payer: Adventist Health Commercial |
$116.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.46
|
| Rate for Payer: Blue Shield of California Commercial |
$219.09
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Central Health Plan Commercial |
$226.74
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.09
|
| Rate for Payer: InnovAge PACE Commercial |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$212.57
|
| Rate for Payer: Networks By Design Commercial |
$141.72
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: Riverside University Health System MISP |
$113.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.92
|
| Rate for Payer: Vantage Medical Group Senior |
$240.92
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
IP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$255.09 |
| Rate for Payer: Adventist Health Commercial |
$56.69
|
| Rate for Payer: Blue Shield of California Commercial |
$219.09
|
| Rate for Payer: Blue Shield of California EPN |
$142.85
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Central Health Plan Commercial |
$226.74
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.69
|
| Rate for Payer: Multiplan Commercial |
$212.57
|
| Rate for Payer: Networks By Design Commercial |
$184.23
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.91 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.81
|
| Rate for Payer: Blue Shield of California Commercial |
$216.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Central Health Plan Commercial |
$224.50
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.57
|
| Rate for Payer: InnovAge PACE Commercial |
$140.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Riverside University Health System MISP |
$112.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Blue Shield of California Commercial |
$216.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Central Health Plan Commercial |
$224.50
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.13
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$182.41
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$11,337.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$10,203.30 |
| Rate for Payer: Adventist Health Commercial |
$4,648.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,069.60
|
| Rate for Payer: Cigna of CA HMO |
$7,255.68
|
| Rate for Payer: Cigna of CA PPO |
$8,389.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$9,636.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,802.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$8,502.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$7,369.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$9,636.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,802.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,802.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$11,337.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$10,203.30 |
| Rate for Payer: Adventist Health Commercial |
$2,267.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,069.60
|
| Rate for Payer: Cigna of CA HMO |
$7,255.68
|
| Rate for Payer: Cigna of CA PPO |
$8,389.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$9,636.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,802.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$8,502.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$7,369.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$9,636.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,802.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,668.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,668.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,668.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,668.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$11,337.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,267.40 |
| Max. Negotiated Rate |
$10,203.30 |
| Rate for Payer: Adventist Health Commercial |
$2,267.40
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,069.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,534.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.80
|
| Rate for Payer: Galaxy Health WC |
$9,636.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,802.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,319.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,017.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.40
|
| Rate for Payer: Multiplan Commercial |
$8,502.75
|
| Rate for Payer: Networks By Design Commercial |
$7,369.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,636.45
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$11,337.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,267.40 |
| Max. Negotiated Rate |
$10,203.30 |
| Rate for Payer: Adventist Health Commercial |
$2,267.40
|
| Rate for Payer: Cash Price |
$5,101.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,069.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,534.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.80
|
| Rate for Payer: Galaxy Health WC |
$9,636.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,802.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,319.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,017.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.40
|
| Rate for Payer: Multiplan Commercial |
$8,502.75
|
| Rate for Payer: Networks By Design Commercial |
$7,369.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,636.45
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$38.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.01
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
