|
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 |
$294.18
|
| Rate for Payer: Blue Shield of California Commercial |
$373.73
|
| Rate for Payer: Blue Shield of California Commercial |
$246.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| 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
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| 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 |
$315.90
|
| 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 |
915354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| 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 |
$315.90
|
| 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 |
$294.18
|
| Rate for Payer: Blue Shield of California Commercial |
$373.73
|
| Rate for Payer: Blue Shield of California Commercial |
$246.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| 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
|
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 |
$168.27
|
| Rate for Payer: Blue Shield of California Commercial |
$213.78
|
| Rate for Payer: Blue Shield of California Commercial |
$140.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| 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 |
$180.70
|
| 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
|
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: Cigna of CA HMO |
$3,001.49
|
| 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 |
$2,595.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,297.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,173.94
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,233.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,722.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,529.83
|
| 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
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,722.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,529.83
|
| 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 |
$2,787.10
|
| 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 |
$2,595.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,297.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,173.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,233.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,722.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,525.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,529.83
|
| 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
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
905354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,722.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,529.83
|
| 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 |
$2,787.10
|
| 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 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 |
$446.11
|
| Rate for Payer: Blue Shield of California Commercial |
$566.75
|
| Rate for Payer: Blue Shield of California Commercial |
$373.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| 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 |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| 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 |
$479.05
|
| 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 |
$446.11
|
| Rate for Payer: Blue Shield of California Commercial |
$566.75
|
| Rate for Payer: Blue Shield of California Commercial |
$373.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$559.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| 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 |
$479.05
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$478.52
|
| 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 |
$5,641.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,169.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,086.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,169.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,086.19
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,216.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,917.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,711.05
|
| 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 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 |
$14,977.17 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,390.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,216.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| 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/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,437.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,163.27
|
| 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 |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,028.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,561.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,238.56
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Adventist Health Commercial |
$1,436.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,028.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| 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/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,561.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| 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 |
$3,592.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,369.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| 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/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,777.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,437.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,163.27
|
| 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 |
$4,549.50
|
| 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 |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
IP
|
$9,099.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,819.80 |
| Max. Negotiated Rate |
$7,734.15 |
| Rate for Payer: Adventist Health Commercial |
$1,819.80
|
| Rate for Payer: Cash Price |
$4,094.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,369.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,639.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,639.60
|
| Rate for Payer: Galaxy Health WC |
$7,734.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,459.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,777.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,368.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.76
|
| Rate for Payer: Multiplan Commercial |
$7,279.20
|
| Rate for Payer: Networks By Design Commercial |
$5,914.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,734.15
|
|
|
HC AIRWAY GUEDEL 100MM RED
|
Facility
|
IP
|
$2.46
|
|
| Hospital Charge Code |
901608005
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
HC AIRWAY GUEDEL 100MM RED
|
Facility
|
OP
|
$2.46
|
|
| Hospital Charge Code |
901608005
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
HC AIRWAY, GUEDEL 110MM, ORANGE
|
Facility
|
IP
|
$3.77
|
|
| Hospital Charge Code |
901608006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
