|
HC SLEEP STUDY UNATTENDEDD
|
Facility
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
903600036
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$722.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,129.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,017.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.13
|
| Rate for Payer: Blue Shield of California EPN |
$824.26
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,272.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$315.00
|
| Rate for Payer: United Healthcare HMO Rider |
$314.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.59
|
| Rate for Payer: BCBS Transplant Transplant |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$103.21
|
| Rate for Payer: Blue Shield of California EPN |
$81.16
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$125.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: IEHP medi-cal |
$111.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Innovage PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: Riverside University Health MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| 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 |
$4,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
IP
|
$678.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$440.70
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
|
|
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 |
$6.14 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.37
|
| Rate for Payer: BCBS Transplant Transplant |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13.16
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.16
|
| Rate for Payer: IEHP medi-cal |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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 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 |
$8.78
|
| Rate for Payer: United Healthcare All Other HMO |
$8.78
|
| Rate for Payer: United Healthcare HMO Rider |
$8.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.78
|
| 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 |
$15.80 |
| Rate for Payer: Blue Shield of California EPN |
$9.37
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| 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 |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
OP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.37
|
| Rate for Payer: BCBS Transplant Transplant |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13.16
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.16
|
| Rate for Payer: IEHP medi-cal |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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 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 |
$8.78
|
| Rate for Payer: United Healthcare All Other HMO |
$8.78
|
| Rate for Payer: United Healthcare HMO Rider |
$8.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM MED DELUXE WITH PAD
|
Facility
IP
|
$17.55
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Blue Shield of California EPN |
$9.37
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| 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 |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
OP
|
$40.84
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.13
|
| Rate for Payer: BCBS Transplant Transplant |
$24.50
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$32.67
|
| Rate for Payer: Cigna of CA HMO |
$28.59
|
| Rate for Payer: Cigna of CA PPO |
$28.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.63
|
| Rate for Payer: IEHP medi-cal |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$30.63
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
| Rate for Payer: Riverside University Health MISP |
$16.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.42
|
| Rate for Payer: United Healthcare All Other HMO |
$20.42
|
| Rate for Payer: United Healthcare HMO Rider |
$20.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.71
|
| Rate for Payer: Vantage Medical Group Senior |
$34.71
|
|
|
HC SLING ARM PEDIATRIC
|
Facility
IP
|
$40.84
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Blue Shield of California EPN |
$21.81
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$32.67
|
| Rate for Payer: Cigna of CA HMO |
$28.59
|
| Rate for Payer: Cigna of CA PPO |
$28.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$30.63
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
|
|
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 |
$15.80 |
| Rate for Payer: Blue Shield of California EPN |
$9.37
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| 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 |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
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 |
$6.14 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.37
|
| Rate for Payer: BCBS Transplant Transplant |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13.16
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$15.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.16
|
| Rate for Payer: IEHP medi-cal |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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 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 |
$8.78
|
| Rate for Payer: United Healthcare All Other HMO |
$8.78
|
| Rate for Payer: United Healthcare HMO Rider |
$8.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Vantage Medical Group Senior |
$14.92
|
|
|
HC SLING ARM XLG
|
Facility
OP
|
$18.45
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.90
|
| Rate for Payer: BCBS Transplant Transplant |
$11.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California EPN |
$10.04
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Central Health Plan Commercial |
$14.76
|
| Rate for Payer: Cigna of CA HMO |
$12.92
|
| Rate for Payer: Cigna of CA PPO |
$12.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.38
|
| Rate for Payer: Galaxy Health WC |
$15.68
|
| Rate for Payer: Global Benefits Group Commercial |
$11.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.84
|
| Rate for Payer: IEHP medi-cal |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$13.84
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$15.68
|
| Rate for Payer: Riverside University Health MISP |
$7.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.68
|
| Rate for Payer: Vantage Medical Group Senior |
$15.68
|
|
|
HC SLING ARM XLG
|
Facility
IP
|
$18.45
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698125
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Blue Shield of California EPN |
$9.85
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Central Health Plan Commercial |
$14.76
|
| Rate for Payer: Cigna of CA HMO |
$12.92
|
| Rate for Payer: Cigna of CA PPO |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.38
|
| Rate for Payer: Galaxy Health WC |
$15.68
|
| Rate for Payer: Global Benefits Group Commercial |
$11.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$13.84
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$15.68
|
|
|
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: Blue Shield of California EPN |
$776.79
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$290.93
|
| Rate for Payer: Multiplan Commercial |
$1,091.00
|
| Rate for Payer: Networks By Design Commercial |
$727.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.46
|
|
|
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 |
$13.19 |
| Max. Negotiated Rate |
$1,309.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,236.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$800.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$800.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$704.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$859.41
|
| Rate for Payer: BCBS Transplant Transplant |
$872.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,091.00
|
| Rate for Payer: Blue Shield of California EPN |
$791.34
|
| Rate for Payer: Cash Price |
$654.60
|
| 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: EPIC Health Plan Commercial |
$581.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,091.00
|
| Rate for Payer: IEHP medi-cal |
$509.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.41
|
| Rate for Payer: Multiplan Commercial |
$1,091.00
|
| 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 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 |
$727.33
|
| Rate for Payer: United Healthcare All Other HMO |
$727.33
|
| Rate for Payer: United Healthcare HMO Rider |
$727.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.33
|
| 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
|
$22.96
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Central Health Plan Commercial |
$18.37
|
| Rate for Payer: Cigna of CA HMO |
$16.07
|
| Rate for Payer: Cigna of CA PPO |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$19.52
|
| Rate for Payer: Global Benefits Group Commercial |
$13.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$19.52
|
|
|
HC SLING DEEP POCKET ARM XL
|
Facility
OP
|
$22.96
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.56
|
| Rate for Payer: BCBS Transplant Transplant |
$13.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.22
|
| Rate for Payer: Blue Shield of California EPN |
$12.49
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Central Health Plan Commercial |
$18.37
|
| Rate for Payer: Cigna of CA HMO |
$16.07
|
| Rate for Payer: Cigna of CA PPO |
$16.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$19.52
|
| Rate for Payer: Global Benefits Group Commercial |
$13.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.22
|
| Rate for Payer: IEHP medi-cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$19.52
|
| Rate for Payer: Riverside University Health MISP |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.48
|
| Rate for Payer: United Healthcare HMO Rider |
$11.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.52
|
| Rate for Payer: Vantage Medical Group Senior |
$19.52
|
|
|
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: Blue Shield of California EPN |
$149.86
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$56.13
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.32
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
|
|
HC SLING ULTRASLING LARGE
|
Facility
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.80
|
| Rate for Payer: BCBS Transplant Transplant |
$168.38
|
| Rate for Payer: Blue Shield of California Commercial |
$210.47
|
| Rate for Payer: Blue Shield of California EPN |
$152.66
|
| Rate for Payer: Cash Price |
$126.28
|
| 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: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$210.47
|
| Rate for Payer: IEHP medi-cal |
$98.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.06
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.32
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Riverside University Health 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 |
$140.32
|
| Rate for Payer: United Healthcare All Other HMO |
$140.32
|
| Rate for Payer: United Healthcare HMO Rider |
$140.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLING ULTRASLING MED
|
Facility
OP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$255.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$155.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$155.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.45
|
| Rate for Payer: BCBS Transplant Transplant |
$170.06
|
| Rate for Payer: Blue Shield of California Commercial |
$212.57
|
| Rate for Payer: Blue Shield of California EPN |
$154.19
|
| Rate for Payer: Cash Price |
$127.54
|
| 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: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$212.57
|
| Rate for Payer: IEHP medi-cal |
$99.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.21
|
| 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 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 |
$141.72
|
| Rate for Payer: United Healthcare All Other HMO |
$141.72
|
| Rate for Payer: United Healthcare HMO Rider |
$141.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.72
|
| 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: Blue Shield of California EPN |
$151.35
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$56.69
|
| 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
|
|
|
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: Blue Shield of California EPN |
$149.86
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$56.13
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.32
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.80
|
| Rate for Payer: BCBS Transplant Transplant |
$168.38
|
| Rate for Payer: Blue Shield of California Commercial |
$210.47
|
| Rate for Payer: Blue Shield of California EPN |
$152.66
|
| Rate for Payer: Cash Price |
$126.28
|
| 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: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$210.47
|
| Rate for Payer: IEHP medi-cal |
$98.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.06
|
| Rate for Payer: Multiplan Commercial |
$210.47
|
| Rate for Payer: Networks By Design Commercial |
$140.32
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Riverside University Health 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 |
$140.32
|
| Rate for Payer: United Healthcare All Other HMO |
$140.32
|
| Rate for Payer: United Healthcare HMO Rider |
$140.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLITTING OF PREPUCE
|
Facility
OP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,714.40 |
| Max. Negotiated Rate |
$7,714.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,143.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,391.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,191.71
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,857.60
|
| Rate for Payer: Cigna of CA HMO |
$5,486.08
|
| Rate for Payer: Cigna of CA PPO |
$6,343.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,714.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,429.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: IEHP medi-cal |
$4,199.04
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Innovage PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,714.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,429.00
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,143.20
|
| Rate for Payer: Riverside University Health MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,143.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,143.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,286.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,286.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,286.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,286.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC SLITTING OF PREPUCE
|
Facility
IP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,714.40 |
| Max. Negotiated Rate |
$7,714.80 |
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,428.80
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,714.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,714.40
|
| Rate for Payer: Multiplan Commercial |
$6,429.00
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
|
