|
HC AIRWAY LMA UNIQUE CUFF 2
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698545
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY LMA UNIQUE CUFF 2
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698545
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY LMA UNIQUE CUFF 2.5
|
Facility
|
OP
|
$47.72
|
|
| Hospital Charge Code |
901698544
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.62
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cigna of CA HMO |
$30.54
|
| Rate for Payer: Cigna of CA PPO |
$35.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.86
|
| Rate for Payer: United Healthcare All Other HMO |
$23.86
|
| Rate for Payer: United Healthcare HMO Rider |
$23.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.56
|
| Rate for Payer: Vantage Medical Group Senior |
$40.56
|
|
|
HC AIRWAY LMA UNIQUE CUFF 2.5
|
Facility
|
IP
|
$47.72
|
|
| Hospital Charge Code |
901698544
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
|
|
HC AIRWAY LMA UNIQUE SIZE 1.5
|
Facility
|
IP
|
$47.72
|
|
| Hospital Charge Code |
901698335
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
|
|
HC AIRWAY LMA UNIQUE SIZE 1.5
|
Facility
|
OP
|
$47.72
|
|
| Hospital Charge Code |
901698335
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.62
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cigna of CA HMO |
$30.54
|
| Rate for Payer: Cigna of CA PPO |
$35.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.86
|
| Rate for Payer: United Healthcare All Other HMO |
$23.86
|
| Rate for Payer: United Healthcare HMO Rider |
$23.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.56
|
| Rate for Payer: Vantage Medical Group Senior |
$40.56
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #3
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #3
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #4
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698542
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #4
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698542
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #5
|
Facility
|
IP
|
$47.72
|
|
| Hospital Charge Code |
901698543
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #5
|
Facility
|
OP
|
$47.72
|
|
| Hospital Charge Code |
901698543
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.62
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cigna of CA HMO |
$30.54
|
| Rate for Payer: Cigna of CA PPO |
$35.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.09
|
| Rate for Payer: Galaxy Health WC |
$40.56
|
| Rate for Payer: Global Benefits Group Commercial |
$28.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$38.18
|
| Rate for Payer: Networks By Design Commercial |
$31.02
|
| Rate for Payer: Prime Health Services Commercial |
$40.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.86
|
| Rate for Payer: United Healthcare All Other HMO |
$23.86
|
| Rate for Payer: United Healthcare HMO Rider |
$23.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.56
|
| Rate for Payer: Vantage Medical Group Senior |
$40.56
|
|
|
HC AIRWAY NASAL ARGYLE 26FR
|
Facility
|
OP
|
$35.92
|
|
| Hospital Charge Code |
901698905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.05
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
HC AIRWAY NASAL ARGYLE 26FR
|
Facility
|
IP
|
$35.92
|
|
| Hospital Charge Code |
901698905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC AIRWAY NASAL ARGYLE 28FR
|
Facility
|
OP
|
$35.92
|
|
| Hospital Charge Code |
901698906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.05
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
HC AIRWAY NASAL ARGYLE 28FR
|
Facility
|
IP
|
$35.92
|
|
| Hospital Charge Code |
901698906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC AIRWAY NASAL ARGYLE 30FR
|
Facility
|
IP
|
$35.92
|
|
| Hospital Charge Code |
901698907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC AIRWAY NASAL ARGYLE 30FR
|
Facility
|
OP
|
$35.92
|
|
| Hospital Charge Code |
901698907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.05
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
HC AIRWAY ORAL GUEDEL 40MM
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
913200776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC AIRWAY ORAL GUEDEL 40MM
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
913200776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.63
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.83 |
| Max. Negotiated Rate |
$14,977.17 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,590.73
|
| 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 |
$265.83
|
| 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 |
$300.64
|
| 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 TRACH/BRONCH REVIS STNT
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
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 AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
OP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,109.52 |
| Max. Negotiated Rate |
$3,929.55 |
| Rate for Payer: Adventist Health Commercial |
$1,895.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,542.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,467.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,798.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,555.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,343.86
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,929.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,929.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,136.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,935.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,415.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,727.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,236.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,236.10
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,773.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,773.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,929.55
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$924.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,935.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,727.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$3,004.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
915355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$924.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,935.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,727.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$3,004.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
|
