|
HC AFO SPRINGWIRE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
915351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$204.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.02
|
| Rate for Payer: Blue Shield of California Commercial |
$368.26
|
| Rate for Payer: Blue Shield of California EPN |
$242.51
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.27
|
| Rate for Payer: United Healthcare All Other HMO |
$182.28
|
| Rate for Payer: United Healthcare HMO Rider |
$178.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.64 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Adventist Health Commercial |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.49
|
| Rate for Payer: Blue Shield of California Commercial |
$358.67
|
| Rate for Payer: Blue Shield of California EPN |
$236.20
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.64 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Adventist Health Commercial |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.49
|
| Rate for Payer: Blue Shield of California Commercial |
$358.67
|
| Rate for Payer: Blue Shield of California EPN |
$236.20
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$205.16
|
| Rate for Payer: Blue Shield of California EPN |
$135.11
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$205.16
|
| Rate for Payer: Blue Shield of California EPN |
$135.11
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$194.60
|
| Rate for Payer: Cigna of CA PPO |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.33
|
| Rate for Payer: United Healthcare All Other HMO |
$101.55
|
| Rate for Payer: United Healthcare HMO Rider |
$99.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.05
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,633.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.08
|
| Rate for Payer: Multiplan Commercial |
$3,430.28
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
905354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,633.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.08
|
| Rate for Payer: Multiplan Commercial |
$3,430.28
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
OP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,029.08 |
| Max. Negotiated Rate |
$3,644.67 |
| Rate for Payer: Adventist Health Commercial |
$1,758.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,358.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,215.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,483.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,164.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,083.90
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,644.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,644.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,233.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,001.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,430.28
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,572.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,572.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3,644.67
|
|
|
HC AFO, WALK BOOT (NEUROPATHIC TYPE) CUSTOM
|
Facility
|
OP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
905354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,029.08 |
| Max. Negotiated Rate |
$3,644.67 |
| Rate for Payer: Adventist Health Commercial |
$1,758.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,358.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,215.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,483.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,164.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,083.90
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cigna of CA HMO |
$3,001.49
|
| Rate for Payer: Cigna of CA PPO |
$3,001.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,644.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,644.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,715.14
|
| Rate for Payer: Galaxy Health WC |
$3,644.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2,572.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,233.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,654.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,001.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,430.28
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,572.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,572.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3,644.67
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Adventist Health Commercial |
$302.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.87
|
| Rate for Payer: Blue Shield of California Commercial |
$543.91
|
| Rate for Payer: Blue Shield of California EPN |
$358.18
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Adventist Health Commercial |
$302.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.87
|
| Rate for Payer: Blue Shield of California Commercial |
$543.91
|
| Rate for Payer: Blue Shield of California EPN |
$358.18
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO |
$515.90
|
| Rate for Payer: Cigna of CA PPO |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$1,841.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,564.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,012.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,380.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Cigna of CA HMO |
$1,178.24
|
| Rate for Payer: Cigna of CA PPO |
$1,362.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,564.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,564.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,564.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$736.40
|
| Rate for Payer: Galaxy Health WC |
$1,564.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,139.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,288.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,288.70
|
| Rate for Payer: Multiplan Commercial |
$1,472.80
|
| Rate for Payer: Networks By Design Commercial |
$1,196.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,104.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,104.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$920.50
|
| Rate for Payer: United Healthcare All Other HMO |
$920.50
|
| Rate for Payer: United Healthcare HMO Rider |
$920.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,564.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,564.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.85
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$1,841.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$1,564.85 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$736.40
|
| Rate for Payer: Galaxy Health WC |
$1,564.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,139.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.84
|
| Rate for Payer: Multiplan Commercial |
$1,472.80
|
| Rate for Payer: Networks By Design Commercial |
$1,196.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.85
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$14,424.93 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cigna of CA HMO |
$2,940.80
|
| Rate for Payer: Cigna of CA PPO |
$3,400.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,064.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$3,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,757.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,757.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,297.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$3,905.75 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,838.00
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,064.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,750.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,844.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.80
|
| Rate for Payer: Multiplan Commercial |
$3,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
OP
|
$7,184.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,436.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,232.80
|
| Rate for Payer: Cash Price |
$3,232.80
|
| Rate for Payer: Cash Price |
$3,232.80
|
| Rate for Payer: Cigna of CA HMO |
$4,597.76
|
| Rate for Payer: Cigna of CA PPO |
$5,316.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,324.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.64
|
| Rate for Payer: Galaxy Health WC |
$6,106.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,310.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,682.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,684.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,277.42
|
| Rate for Payer: Multiplan Commercial |
$5,747.20
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$4,669.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,106.40
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,310.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,684.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
IP
|
$7,184.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,436.80 |
| Max. Negotiated Rate |
$6,106.40 |
| Rate for Payer: Adventist Health Commercial |
$1,436.80
|
| Rate for Payer: Cash Price |
$3,232.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,873.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,873.60
|
| Rate for Payer: Galaxy Health WC |
$6,106.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,310.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,446.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.16
|
| Rate for Payer: Multiplan Commercial |
$5,747.20
|
| Rate for Payer: Networks By Design Commercial |
$4,669.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,106.40
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
OP
|
$9,099.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.25 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,094.55
|
| Rate for Payer: Cash Price |
$4,094.55
|
| Rate for Payer: Cash Price |
$4,094.55
|
| Rate for Payer: Cigna of CA HMO |
$5,823.36
|
| Rate for Payer: Cigna of CA PPO |
$6,733.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$7,734.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,459.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,069.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$7,279.20
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$5,914.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,734.15
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,459.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
