|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.87
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$302.06
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.81
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
915353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
905353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
915353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC SHOE CONVERT TO SOFT COUNTER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3590
|
| Hospital Charge Code |
905353590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SHOE CUSTOM FITTED PLASTIZOTE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L3253
|
| Hospital Charge Code |
905353253
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.19
|
| Rate for Payer: Blue Shield of California Commercial |
$99.63
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC SHOE CUSTOM FITTED PLASTIZOTE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3253
|
| Hospital Charge Code |
905353253
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC SHOE CUSTOM PROSTHETIC EA
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT L3250
|
| Hospital Charge Code |
905353250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$442.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.54
|
| Rate for Payer: Blue Shield of California Commercial |
$797.04
|
| Rate for Payer: Blue Shield of California EPN |
$524.88
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$756.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$918.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$756.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$756.00
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$540.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$648.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.32
|
| Rate for Payer: United Healthcare All Other HMO |
$394.52
|
| Rate for Payer: United Healthcare HMO Rider |
$385.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$918.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.00
|
| Rate for Payer: Vantage Medical Group Senior |
$918.00
|
|
|
HC SHOE CUSTOM PROSTHETIC EA
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT L3250
|
| Hospital Charge Code |
905353250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO |
$756.00
|
| Rate for Payer: Cigna of CA PPO |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$540.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.32
|
| Rate for Payer: United Healthcare All Other HMO |
$394.52
|
| Rate for Payer: United Healthcare HMO Rider |
$385.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.70
|
|
|
HC SHOE HIGHTOP CHILD
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L3206
|
| Hospital Charge Code |
905353206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$58.85
|
| Rate for Payer: Cash Price |
$58.85
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
