|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
IP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$424.75 |
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Central Health Plan Commercial |
$377.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.78
|
| Rate for Payer: Galaxy Health WC |
$401.15
|
| Rate for Payer: Global Benefits Group Commercial |
$283.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$353.96
|
| Rate for Payer: Networks By Design Commercial |
$306.76
|
| Rate for Payer: Prime Health Services Commercial |
$401.15
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
OP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.16
|
| Rate for Payer: Blue Distinction Transplant |
$229.68
|
| Rate for Payer: Blue Shield of California Commercial |
$240.78
|
| Rate for Payer: Blue Shield of California EPN |
$187.19
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Media |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$287.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
| Rate for Payer: Riverside University Health System MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
IP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.93
|
| Rate for Payer: Blue Distinction Transplant |
$216.25
|
| Rate for Payer: Blue Shield of California Commercial |
$226.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.24
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Media |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Riverside University Health System MISP |
$144.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other HMO |
$180.20
|
| Rate for Payer: United Healthcare HMO Rider |
$180.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.93
|
| Rate for Payer: Blue Distinction Transplant |
$216.25
|
| Rate for Payer: Blue Shield of California Commercial |
$226.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.24
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Media |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Riverside University Health System MISP |
$144.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other HMO |
$180.20
|
| Rate for Payer: United Healthcare HMO Rider |
$180.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.93
|
| Rate for Payer: Blue Distinction Transplant |
$216.25
|
| Rate for Payer: Blue Shield of California Commercial |
$226.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.24
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Media |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Riverside University Health System MISP |
$144.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other HMO |
$180.20
|
| Rate for Payer: United Healthcare HMO Rider |
$180.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
IP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Central Health Plan Commercial |
$300.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.10
|
| Rate for Payer: Galaxy Health WC |
$318.97
|
| Rate for Payer: Global Benefits Group Commercial |
$225.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: Networks By Design Commercial |
$243.92
|
| Rate for Payer: Prime Health Services Commercial |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$206.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.70
|
| Rate for Payer: Blue Distinction Transplant |
$225.16
|
| Rate for Payer: Blue Shield of California Commercial |
$236.04
|
| Rate for Payer: Blue Shield of California EPN |
$183.50
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Central Health Plan Commercial |
$300.21
|
| Rate for Payer: Cigna of CA HMO |
$240.17
|
| Rate for Payer: Cigna of CA PPO |
$277.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.97
|
| Rate for Payer: Dignity Health Media |
$318.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.10
|
| Rate for Payer: Galaxy Health WC |
$318.97
|
| Rate for Payer: Global Benefits Group Commercial |
$225.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$281.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: Networks By Design Commercial |
$243.92
|
| Rate for Payer: Prime Health Services Commercial |
$318.97
|
| Rate for Payer: Riverside University Health System MISP |
$150.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.63
|
| Rate for Payer: United Healthcare All Other HMO |
$187.63
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.97
|
| Rate for Payer: Vantage Medical Group Senior |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.93
|
| Rate for Payer: Blue Distinction Transplant |
$216.25
|
| Rate for Payer: Blue Shield of California Commercial |
$226.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.24
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Media |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Riverside University Health System MISP |
$144.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other HMO |
$180.20
|
| Rate for Payer: United Healthcare HMO Rider |
$180.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
905355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Blue Shield of California EPN |
$354.04
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.35
|
| Rate for Payer: United Healthcare All Other HMO |
$244.51
|
| Rate for Payer: United Healthcare HMO Rider |
$239.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$218.79
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
905355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.70
|
| Rate for Payer: Blue Distinction Transplant |
$397.80
|
| Rate for Payer: Blue Shield of California Commercial |
$497.25
|
| Rate for Payer: Blue Shield of California EPN |
$360.67
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.55
|
| Rate for Payer: Dignity Health Media |
$563.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$497.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.83
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Riverside University Health System MISP |
$265.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.50
|
| Rate for Payer: United Healthcare All Other HMO |
$331.50
|
| Rate for Payer: United Healthcare HMO Rider |
$331.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.55
|
| Rate for Payer: Vantage Medical Group Senior |
$563.55
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.10 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$883.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$777.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$948.82
|
| Rate for Payer: Blue Distinction Transplant |
$963.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.50
|
| Rate for Payer: Blue Shield of California EPN |
$873.66
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Media |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,204.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$562.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.46
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Riverside University Health System MISP |
$642.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$803.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$803.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Blue Shield of California EPN |
$857.60
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.43
|
| Rate for Payer: United Healthcare All Other HMO |
$592.29
|
| Rate for Payer: United Healthcare HMO Rider |
$579.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$529.98
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Blue Shield of California EPN |
$988.43
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.20
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.94
|
| Rate for Payer: United Healthcare All Other HMO |
$682.65
|
| Rate for Payer: United Healthcare HMO Rider |
$667.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.83
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,018.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$896.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,093.57
|
| Rate for Payer: Blue Distinction Transplant |
$1,110.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,388.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,006.94
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Media |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,388.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.91
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Riverside University Health System MISP |
$740.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$925.50
|
| Rate for Payer: United Healthcare All Other HMO |
$925.50
|
| Rate for Payer: United Healthcare HMO Rider |
$925.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Blue Shield of California EPN |
$561.77
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$397.24
|
| Rate for Payer: United Healthcare All Other HMO |
$387.98
|
| Rate for Payer: United Healthcare HMO Rider |
$379.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.16
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$578.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$509.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.52
|
| Rate for Payer: Blue Distinction Transplant |
$631.20
|
| Rate for Payer: Blue Shield of California Commercial |
$789.00
|
| Rate for Payer: Blue Shield of California EPN |
$572.29
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Media |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$789.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.32
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Other HMO |
$526.00
|
| Rate for Payer: United Healthcare HMO Rider |
$526.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Blue Shield of California EPN |
$828.77
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.04
|
| Rate for Payer: United Healthcare All Other HMO |
$572.38
|
| Rate for Payer: United Healthcare HMO Rider |
$559.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$512.16
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$543.20 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$751.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$916.92
|
| Rate for Payer: Blue Distinction Transplant |
$931.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.00
|
| Rate for Payer: Blue Shield of California EPN |
$844.29
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Media |
$1,319.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,164.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$543.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.32
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Riverside University Health System MISP |
$620.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$776.00
|
| Rate for Payer: United Healthcare All Other HMO |
$776.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$776.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
