|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Blue Shield of California EPN |
$855.47
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$604.92
|
| Rate for Payer: United Healthcare All Other HMO |
$590.82
|
| Rate for Payer: United Healthcare HMO Rider |
$578.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.66
|
|
|
HC AFO SPIRAL PLASTIC CUSTOM
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT L1950
|
| Hospital Charge Code |
905351950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$560.70 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$775.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$946.46
|
| Rate for Payer: Blue Distinction Transplant |
$961.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,201.50
|
| Rate for Payer: Blue Shield of California EPN |
$871.49
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: Cigna of CA HMO |
$1,121.40
|
| Rate for Payer: Cigna of CA PPO |
$1,121.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.70
|
| Rate for Payer: Dignity Health Media |
$1,361.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,201.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$560.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.82
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$801.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
| Rate for Payer: Riverside University Health System MISP |
$640.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.00
|
| Rate for Payer: United Healthcare All Other HMO |
$801.00
|
| Rate for Payer: United Healthcare HMO Rider |
$801.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$801.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,361.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,361.70
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Blue Shield of California EPN |
$755.08
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.93
|
| Rate for Payer: United Healthcare All Other HMO |
$521.48
|
| Rate for Payer: United Healthcare HMO Rider |
$510.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.62
|
|
|
HC AFO SPIRAL PREFAB FIT & ADJ
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1951
|
| Hospital Charge Code |
905351951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$494.90 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$684.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$835.39
|
| Rate for Payer: Blue Distinction Transplant |
$848.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,060.50
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Media |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,060.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.74
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Riverside University Health System MISP |
$565.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$707.00
|
| Rate for Payer: United Healthcare All Other HMO |
$707.00
|
| Rate for Payer: United Healthcare HMO Rider |
$707.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
905351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Blue Shield of California EPN |
$266.47
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.42
|
| Rate for Payer: United Healthcare All Other HMO |
$184.03
|
| Rate for Payer: United Healthcare HMO Rider |
$180.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.67
|
|
|
HC AFO SPRINGWIRE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT L1900
|
| Hospital Charge Code |
905351900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.81
|
| Rate for Payer: Blue Distinction Transplant |
$299.40
|
| Rate for Payer: Blue Shield of California Commercial |
$374.25
|
| Rate for Payer: Blue Shield of California EPN |
$271.46
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$349.30
|
| Rate for Payer: Cigna of CA PPO |
$349.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Media |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$374.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.59
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$249.50
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$437.40 |
| 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 |
$267.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.13
|
| Rate for Payer: Blue Distinction Transplant |
$291.60
|
| Rate for Payer: Blue Shield of California Commercial |
$364.50
|
| Rate for Payer: Blue Shield of California EPN |
$264.38
|
| 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 Media |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.26
|
| 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 |
$243.00
|
| Rate for Payer: United Healthcare All Other HMO |
$243.00
|
| Rate for Payer: United Healthcare HMO Rider |
$243.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC AFO STATIC/DYNAMIC MULTI PODUS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
905354310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Blue Shield of California EPN |
$259.52
|
| 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: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| 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: United Healthcare All Other Commercial |
$183.51
|
| Rate for Payer: United Healthcare All Other HMO |
$179.24
|
| Rate for Payer: United Healthcare HMO Rider |
$175.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.38
|
|
|
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 |
$3,859.06 |
| Rate for Payer: Blue Shield of California EPN |
$2,289.71
|
| 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 |
$3,001.50
|
| Rate for Payer: Cigna of CA PPO |
$3,001.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$3,859.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,633.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.57
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.92
|
| Rate for Payer: Prime Health Services Commercial |
$3,644.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,619.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,581.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1,547.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,414.99
|
|
|
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 |
$1,500.75 |
| Max. Negotiated Rate |
$3,859.06 |
| 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 |
$2,358.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,076.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,533.26
|
| Rate for Payer: Blue Distinction Transplant |
$2,572.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,215.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,332.59
|
| 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 |
$3,001.50
|
| Rate for Payer: Cigna of CA PPO |
$3,001.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,644.67
|
| Rate for Payer: Dignity Health Media |
$3,644.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,644.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,715.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$3,859.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,215.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,500.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,860.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.02
|
| Rate for Payer: Multiplan Commercial |
$3,215.89
|
| Rate for Payer: Networks By Design Commercial |
$2,143.92
|
| 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 |
$2,143.92
|
| Rate for Payer: United Healthcare All Other HMO |
$2,143.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,143.92
|
| 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
|
OP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$257.95 |
| Max. Negotiated Rate |
$663.30 |
| 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 |
$405.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.42
|
| Rate for Payer: Blue Distinction Transplant |
$442.20
|
| Rate for Payer: Blue Shield of California Commercial |
$552.75
|
| Rate for Payer: Blue Shield of California EPN |
$400.93
|
| 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 Media |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$552.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.17
|
| 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 |
$368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$368.50
|
| Rate for Payer: United Healthcare HMO Rider |
$368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC AFO W/ANKLE JOINT PREFAB
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT L1971
|
| Hospital Charge Code |
905351971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Blue Shield of California EPN |
$393.56
|
| 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: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| 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 |
$368.50
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.29
|
| Rate for Payer: United Healthcare All Other HMO |
$271.81
|
| Rate for Payer: United Healthcare HMO Rider |
$265.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.21
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$2,622.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.40 |
| Max. Negotiated Rate |
$2,359.80 |
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,048.80
|
| Rate for Payer: Galaxy Health WC |
$2,228.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,359.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,748.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.40
|
| Rate for Payer: Multiplan Commercial |
$1,966.50
|
| Rate for Payer: Networks By Design Commercial |
$1,704.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,228.70
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$2,622.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.04 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,228.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,442.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,573.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,282.16
|
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,097.60
|
| Rate for Payer: Cigna of CA HMO |
$1,678.08
|
| Rate for Payer: Cigna of CA PPO |
$1,940.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,228.70
|
| Rate for Payer: Dignity Health Media |
$2,228.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,048.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,048.80
|
| Rate for Payer: Galaxy Health WC |
$2,228.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,359.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,966.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$917.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,748.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.40
|
| Rate for Payer: Multiplan Commercial |
$1,966.50
|
| Rate for Payer: Networks By Design Commercial |
$1,704.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,228.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,048.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,573.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,573.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,311.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,228.70
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$6,545.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,309.00 |
| Max. Negotiated Rate |
$5,890.50 |
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,236.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,618.00
|
| Rate for Payer: Galaxy Health WC |
$5,563.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,927.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,890.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,493.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.00
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: Networks By Design Commercial |
$4,254.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,563.25
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$6,545.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.18 |
| Max. Negotiated Rate |
$14,109.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,927.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,200.50
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,236.00
|
| Rate for Payer: Cigna of CA HMO |
$4,188.80
|
| Rate for Payer: Cigna of CA PPO |
$4,843.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$5,563.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,927.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,890.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,908.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,109.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: Networks By Design Commercial |
$4,254.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,563.25
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Riverside University Health System MISP |
$9,406.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,927.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,927.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,272.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,272.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,272.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,272.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
IP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,046.40 |
| Max. Negotiated Rate |
$9,208.80 |
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,092.80
|
| Rate for Payer: Galaxy Health WC |
$8,697.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,824.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,898.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.40
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
| Rate for Payer: Networks By Design Commercial |
$6,650.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,697.20
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
OP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,139.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,678.93
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,185.60
|
| Rate for Payer: Cigna of CA PPO |
$7,571.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$8,697.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,208.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,674.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,720.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: InnovAge PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,824.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
| Rate for Payer: Networks By Design Commercial |
$6,650.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,697.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Riverside University Health System MISP |
$5,146.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
OP
|
$12,959.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.84 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Distinction Transplant |
$7,775.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Cash Price |
$5,831.55
|
| Rate for Payer: Cash Price |
$5,831.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,367.20
|
| Rate for Payer: Cigna of CA PPO |
$9,589.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$11,015.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,775.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,663.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,719.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,109.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,643.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$9,719.25
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Networks By Design Commercial |
$8,423.35
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Commercial |
$11,015.15
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health System MISP |
$9,406.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,775.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
IP
|
$12,959.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,591.80 |
| Max. Negotiated Rate |
$11,663.10 |
| Rate for Payer: Cash Price |
$5,831.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,183.60
|
| Rate for Payer: Galaxy Health WC |
$11,015.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,775.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,663.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,643.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,937.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.80
|
| Rate for Payer: Multiplan Commercial |
$9,719.25
|
| Rate for Payer: Networks By Design Commercial |
$8,423.35
|
| Rate for Payer: Prime Health Services Commercial |
$11,015.15
|
|
|
HC AIRWAY GUEDEL 100MM RED
|
Facility
|
OP
|
$3.36
|
|
| Hospital Charge Code |
901608005
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: Blue Distinction Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
HC AIRWAY GUEDEL 100MM RED
|
Facility
|
IP
|
$3.36
|
|
| Hospital Charge Code |
901608005
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
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: 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 |
$2.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.23
|
| Rate for Payer: Blue Distinction Transplant |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| 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 Media |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| 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
|
| 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 |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
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: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| 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 40MM, PINK
|
Facility
|
OP
|
$3.69
|
|
| Hospital Charge Code |
901607999
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.18
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.36
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Riverside University Health System MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
