|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Adventist Health Commercial |
$578.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$776.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.06
|
| Rate for Payer: Blue Shield of California EPN |
$686.23
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,200.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.40
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,200.20
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
905354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
905354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Adventist Health Commercial |
$578.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$776.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.06
|
| Rate for Payer: Blue Shield of California EPN |
$686.23
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cash Price |
$776.60
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,200.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.40
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,200.20
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
915354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$469.92 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$802.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$951.59
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
915354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$469.92 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$802.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$951.59
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,243.40 |
| Max. Negotiated Rate |
$9,534.45 |
| Rate for Payer: Adventist Health Commercial |
$2,243.40
|
| Rate for Payer: Cash Price |
$6,169.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,486.80
|
| Rate for Payer: Galaxy Health WC |
$9,534.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,730.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,481.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,273.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,943.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Multiplan Commercial |
$8,973.60
|
| Rate for Payer: Networks By Design Commercial |
$7,291.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,534.45
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,344.70 |
| Rate for Payer: Adventist Health Commercial |
$2,243.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$6,169.35
|
| Rate for Payer: Cash Price |
$6,169.35
|
| Rate for Payer: Cash Price |
$6,169.35
|
| Rate for Payer: Cigna of CA HMO |
$7,178.88
|
| Rate for Payer: Cigna of CA PPO |
$8,300.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$9,534.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,730.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,481.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$8,973.60
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$7,291.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,534.45
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,608.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,608.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,608.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,608.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
915368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
915368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.48
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
905368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.48
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
905368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
915354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
915354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.32
|
| Rate for Payer: Blue Shield of California Commercial |
$16.97
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
905354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.32
|
| Rate for Payer: Blue Shield of California Commercial |
$16.97
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
905354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
|
|
HC REPLACE TRILAT SOCKET
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
905354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$612.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$865.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,103.31
|
| Rate for Payer: Blue Shield of California EPN |
$726.57
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$737.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.07
|
| Rate for Payer: United Healthcare All Other HMO |
$546.12
|
| Rate for Payer: United Healthcare HMO Rider |
$534.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC REPLACE TRILAT SOCKET
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
905354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.07
|
| Rate for Payer: United Healthcare All Other HMO |
$546.12
|
| Rate for Payer: United Healthcare HMO Rider |
$534.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.61
|
|
|
HC REPLACE TRILAT SOCKET
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
915354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.07
|
| Rate for Payer: United Healthcare All Other HMO |
$546.12
|
| Rate for Payer: United Healthcare HMO Rider |
$534.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.61
|
|
|
HC REPLACE TRILAT SOCKET
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
915354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$612.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$865.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,103.31
|
| Rate for Payer: Blue Shield of California EPN |
$726.57
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$737.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.07
|
| Rate for Payer: United Healthcare All Other HMO |
$546.12
|
| Rate for Payer: United Healthcare HMO Rider |
$534.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$13,076.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,615.20 |
| Max. Negotiated Rate |
$11,114.60 |
| Rate for Payer: Adventist Health Commercial |
$2,615.20
|
| Rate for Payer: Cash Price |
$7,191.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,230.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,230.40
|
| Rate for Payer: Galaxy Health WC |
$11,114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,845.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,721.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,981.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,094.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,138.24
|
| Rate for Payer: Multiplan Commercial |
$10,460.80
|
| Rate for Payer: Networks By Design Commercial |
$8,499.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,114.60
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$13,076.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$554.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,615.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$7,191.80
|
| Rate for Payer: Cash Price |
$7,191.80
|
| Rate for Payer: Cash Price |
$7,191.80
|
| Rate for Payer: Cigna of CA HMO |
$8,368.64
|
| Rate for Payer: Cigna of CA PPO |
$9,676.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,845.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,721.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,138.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,460.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,499.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,114.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,845.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$11,530.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,306.00 |
| Max. Negotiated Rate |
$9,800.50 |
| Rate for Payer: Adventist Health Commercial |
$2,306.00
|
| Rate for Payer: Cash Price |
$6,341.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,612.00
|
| Rate for Payer: Galaxy Health WC |
$9,800.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,690.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,392.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,137.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,767.20
|
| Rate for Payer: Multiplan Commercial |
$9,224.00
|
| Rate for Payer: Networks By Design Commercial |
$7,494.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,800.50
|
|
