|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$896.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.08
|
| 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 |
$917.80
|
| 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 |
$854.68
|
| Rate for Payer: Blue Shield of California Commercial |
$715.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,085.83
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$896.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.08
|
| 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 |
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 |
$1,185.18
|
| Rate for Payer: Blue Shield of California Commercial |
$992.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.70
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| 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 |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| 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 |
$1,272.70
|
| 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 |
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 |
$1,185.18
|
| Rate for Payer: Blue Shield of California Commercial |
$992.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.70
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| 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 |
$1,272.70
|
| 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/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
456
|
| 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 |
$5,047.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,851.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,122.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,618.03
|
| 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 |
$18,623.90 |
| Rate for Payer: Adventist Health Commercial |
$2,243.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| 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 |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| 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/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,122.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,133.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,221.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,124.86
|
| 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 |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$18,623.90 |
| Rate for Payer: Adventist Health Commercial |
$4,598.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,206.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| 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 |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| 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/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,122.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,133.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,221.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,124.86
|
| 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: TriValley Medical Group Commercial/Senior |
$6,730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
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 |
$5,047.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,851.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,122.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,618.03
|
| 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 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 |
$67.38
|
| Rate for Payer: Cash Price |
$47.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| 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: 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 |
$67.38
|
| Rate for Payer: Cash Price |
$47.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| 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: 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 |
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 |
$47.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| 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
|
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 |
$47.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| 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
|
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 |
$13.92
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| 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 |
915354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| 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 |
$14.95
|
| 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 |
$13.92
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| 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 |
$14.95
|
| 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
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
905354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$949.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.05
|
| 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 |
$971.75
|
| 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 |
$904.92
|
| Rate for Payer: Blue Shield of California Commercial |
$757.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,149.65
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$737.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$949.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.05
|
| 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
|
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 |
$904.92
|
| Rate for Payer: Blue Shield of California Commercial |
$757.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,149.65
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$737.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$949.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.05
|
| 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 |
915354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.50
|
| Rate for Payer: Cigna of CA PPO |
$1,046.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$949.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.05
|
| 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 |
$971.75
|
| 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 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 |
$5,884.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,153.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,303.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,714.84
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,615.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$5,884.20
|
| Rate for Payer: Cash Price |
$5,884.20
|
| Rate for Payer: Cash Price |
$5,884.20
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,153.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,303.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,138.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$6,538.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$9,800.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$554.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,960.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cigna of CA HMO |
$6,272.00
|
| Rate for Payer: Cigna of CA PPO |
$7,252.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$8,330.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,880.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,223.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,352.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$7,840.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,370.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,330.00
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,880.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,900.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
