|
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 |
$159.16 |
| Max. Negotiated Rate |
$437.40 |
| 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 |
$282.71
|
| Rate for Payer: Blue Shield of California Commercial |
$389.77
|
| Rate for Payer: Blue Shield of California EPN |
$244.94
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| 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: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| 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 |
$199.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Riverside University Health System MISP |
$194.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Blue Shield of California Commercial |
$222.96
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| 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: Health Management Network EPO/PPO |
$250.20
|
| 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 |
$55.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| 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 STATIC/DYNAMIC MULTI PODUS SYSTEM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
915354396
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.71
|
| Rate for Payer: Blue Shield of California Commercial |
$222.96
|
| Rate for Payer: Blue Shield of California EPN |
$140.11
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| 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: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.83
|
| 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 |
$113.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$139.00
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Riverside University Health System MISP |
$111.20
|
| 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, 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 |
$1,404.27 |
| Max. Negotiated Rate |
$3,859.07 |
| 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 |
$2,494.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,438.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| 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: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,286.43
|
| 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 |
$1,758.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,715.14
|
| 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 |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,438.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| 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: Health Management Network EPO/PPO |
$3,859.07
|
| 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 |
$857.57
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| 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
|
IP
|
$4,287.85
|
|
|
Service Code
|
CPT L4631
|
| Hospital Charge Code |
915354631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.57 |
| Max. Negotiated Rate |
$3,859.07 |
| Rate for Payer: Adventist Health Commercial |
$857.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,438.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| 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: Health Management Network EPO/PPO |
$3,859.07
|
| 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 |
$857.57
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| 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 |
$1,404.27 |
| Max. Negotiated Rate |
$3,859.07 |
| 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 |
$2,494.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,438.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,161.08
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Cash Price |
$1,929.53
|
| Rate for Payer: Central Health Plan Commercial |
$3,430.28
|
| 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: Health Management Network EPO/PPO |
$3,859.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,286.43
|
| 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 |
$1,758.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,001.49
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,715.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,572.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,572.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,566.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,532.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,644.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3,644.67
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$591.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| 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: Health Management Network EPO/PPO |
$663.30
|
| 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 |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| 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
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$591.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| 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: Health Management Network EPO/PPO |
$663.30
|
| 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 |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| 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 |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.37 |
| Max. Negotiated Rate |
$663.30 |
| 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 |
$428.71
|
| Rate for Payer: Blue Shield of California Commercial |
$591.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| 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: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$506.78
|
| 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 |
$302.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.60
|
| Rate for Payer: United Healthcare All Other HMO |
$269.23
|
| Rate for Payer: United Healthcare HMO Rider |
$263.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
915351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.37 |
| Max. Negotiated Rate |
$663.30 |
| 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 |
$428.71
|
| Rate for Payer: Blue Shield of California Commercial |
$591.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| 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: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$506.78
|
| 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 |
$302.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| 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 AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,698.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,957.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.11
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,470.40
|
| Rate for Payer: Cigna of CA HMO |
$1,976.32
|
| Rate for Payer: Cigna of CA PPO |
$2,285.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,624.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,624.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,161.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.20
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,779.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,960.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,821.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,235.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,852.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,544.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,544.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,544.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,544.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,624.80
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.60 |
| Max. Negotiated Rate |
$2,779.20 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,470.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,161.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.20
|
| Rate for Payer: Galaxy Health WC |
$2,624.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,779.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,960.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,821.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Networks By Design Commercial |
$2,007.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,624.80
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$7,709.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$14,977.17 |
| Rate for Payer: Adventist Health Commercial |
$1,541.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,227.20
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,887.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,075.89
|
| Rate for Payer: Cash Price |
$3,469.05
|
| Rate for Payer: Cash Price |
$3,469.05
|
| Rate for Payer: Cash Price |
$3,469.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,167.20
|
| Rate for Payer: Cigna of CA HMO |
$4,933.76
|
| Rate for Payer: Cigna of CA PPO |
$5,704.66
|
| 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 |
$5,396.30
|
| 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 |
$6,552.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,625.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,938.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,895.22
|
| 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 |
$1,541.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$5,781.75
|
| Rate for Payer: Networks By Design Commercial |
$5,010.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Prime Health Services Commercial |
$6,552.65
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,625.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,625.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,854.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,854.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,854.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,854.50
|
| 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 DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$7,709.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,541.80 |
| Max. Negotiated Rate |
$6,938.10 |
| Rate for Payer: Adventist Health Commercial |
$1,541.80
|
| Rate for Payer: Cash Price |
$3,469.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,167.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,396.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,083.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,083.60
|
| Rate for Payer: Galaxy Health WC |
$6,552.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,625.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,938.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,895.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,548.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.80
|
| Rate for Payer: Multiplan Commercial |
$5,781.75
|
| Rate for Payer: Networks By Design Commercial |
$5,010.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,552.65
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
IP
|
$12,051.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,410.20 |
| Max. Negotiated Rate |
$10,845.90 |
| Rate for Payer: Adventist Health Commercial |
$2,410.20
|
| Rate for Payer: Cash Price |
$5,422.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,640.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,435.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,820.40
|
| Rate for Payer: Galaxy Health WC |
$10,243.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,230.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,845.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,652.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,110.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.20
|
| Rate for Payer: Multiplan Commercial |
$9,038.25
|
| Rate for Payer: Networks By Design Commercial |
$7,833.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,243.35
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
OP
|
$12,051.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,410.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,422.95
|
| Rate for Payer: Cash Price |
$5,422.95
|
| Rate for Payer: Cash Price |
$5,422.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,640.80
|
| Rate for Payer: Cigna of CA HMO |
$7,712.64
|
| Rate for Payer: Cigna of CA PPO |
$8,917.74
|
| 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 |
$8,435.70
|
| 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 |
$10,243.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,230.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,845.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,652.39
|
| 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 |
$2,410.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$9,038.25
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$7,833.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Commercial |
$10,243.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,230.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,025.50
|
| 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 |
$4,795.28
|
| 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
|
$15,262.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.99 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,052.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,867.90
|
| Rate for Payer: Cash Price |
$6,867.90
|
| Rate for Payer: Cash Price |
$6,867.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,209.60
|
| Rate for Payer: Cigna of CA HMO |
$9,767.68
|
| Rate for Payer: Cigna of CA PPO |
$11,293.88
|
| 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 |
$10,683.40
|
| 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 |
$12,972.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,735.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,691.37
|
| 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 |
$3,052.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$11,446.50
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$9,920.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Commercial |
$12,972.70
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,631.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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
|
$15,262.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,052.40 |
| Max. Negotiated Rate |
$13,735.80 |
| Rate for Payer: Adventist Health Commercial |
$3,052.40
|
| Rate for Payer: Cash Price |
$6,867.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,683.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,104.80
|
| Rate for Payer: Galaxy Health WC |
$12,972.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,735.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,691.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,004.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,052.40
|
| Rate for Payer: Multiplan Commercial |
$11,446.50
|
| Rate for Payer: Networks By Design Commercial |
$9,920.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,972.70
|
|
|
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 |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| 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: Health Management Network EPO/PPO |
$2.21
|
| 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 |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| 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 |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| 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 Exchange |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| 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: Health Management Network EPO/PPO |
$2.21
|
| 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 |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.98
|
| 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 |
$3.39 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| 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: Health Management Network EPO/PPO |
$3.39
|
| 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 |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
HC AIRWAY, GUEDEL 110MM, ORANGE
|
Facility
|
OP
|
$3.77
|
|
| Hospital Charge Code |
901608006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| 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: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Riverside University Health System MISP |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
HC AIRWAY, GUEDEL 40MM, PINK
|
Facility
|
IP
|
$3.61
|
|
| Hospital Charge Code |
901607999
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
|
|
HC AIRWAY, GUEDEL 40MM, PINK
|
Facility
|
OP
|
$3.61
|
|
| Hospital Charge Code |
901607999
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Vantage Medical Group Senior |
$3.07
|
|
