|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$9,800.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,960.00 |
| Max. Negotiated Rate |
$8,330.00 |
| Rate for Payer: Adventist Health Commercial |
$1,960.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,920.00
|
| Rate for Payer: Galaxy Health WC |
$8,330.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,880.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,223.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,352.00
|
| Rate for Payer: Multiplan Commercial |
$7,840.00
|
| Rate for Payer: Networks By Design Commercial |
$6,370.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,330.00
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
OP
|
$5,351.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$9,759.00 |
| Rate for Payer: Adventist Health Commercial |
$1,070.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Cash Price |
$2,407.95
|
| Rate for Payer: Cash Price |
$2,407.95
|
| Rate for Payer: Cash Price |
$2,407.95
|
| Rate for Payer: Cigna of CA HMO |
$3,424.64
|
| Rate for Payer: Cigna of CA PPO |
$3,959.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,745.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$4,548.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,397.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,626.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$4,280.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,478.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,548.35
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,210.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,675.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
IP
|
$5,351.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,070.20 |
| Max. Negotiated Rate |
$4,548.35 |
| Rate for Payer: Adventist Health Commercial |
$1,070.20
|
| Rate for Payer: Cash Price |
$2,407.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,745.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,140.40
|
| Rate for Payer: Galaxy Health WC |
$4,548.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,397.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,157.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.24
|
| Rate for Payer: Multiplan Commercial |
$4,280.80
|
| Rate for Payer: Networks By Design Commercial |
$3,478.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,548.35
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$8,852.75 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,144.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| 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 |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| 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 |
$7,290.50
|
| 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 |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$247.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| 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 |
$8,332.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| 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 REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,199.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$839.80 |
| Max. Negotiated Rate |
$3,569.15 |
| Rate for Payer: Adventist Health Commercial |
$839.80
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,939.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,679.60
|
| Rate for Payer: Galaxy Health WC |
$3,569.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,519.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,666.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,477.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$3,359.20
|
| Rate for Payer: Networks By Design Commercial |
$2,729.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,569.15
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,199.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$839.80 |
| Max. Negotiated Rate |
$3,569.15 |
| Rate for Payer: Adventist Health Commercial |
$839.80
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,939.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,679.60
|
| Rate for Payer: Galaxy Health WC |
$3,569.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,519.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,666.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,477.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$3,359.20
|
| Rate for Payer: Networks By Design Commercial |
$2,729.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,569.15
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,199.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.71 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$839.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cigna of CA HMO |
$2,687.36
|
| Rate for Payer: Cigna of CA PPO |
$3,107.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,939.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,569.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,519.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,666.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,359.20
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,729.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,519.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,099.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,199.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$839.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cash Price |
$1,889.55
|
| Rate for Payer: Cigna of CA HMO |
$2,687.36
|
| Rate for Payer: Cigna of CA PPO |
$3,107.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,939.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,569.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,519.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,666.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,359.20
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,729.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,519.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,099.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,099.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,099.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$2,368.95 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.80
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,644.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cigna of CA HMO |
$1,783.68
|
| Rate for Payer: Cigna of CA PPO |
$2,062.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,672.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,443.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$2,823.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,131.60
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,195.20 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,014.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,829.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,524.86
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,208.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,162.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,938.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,195.20 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,014.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,829.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,524.86
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,208.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,162.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,938.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,162.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,938.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$3,237.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,162.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,938.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$3,237.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,443.75 |
| Rate for Payer: Adventist Health Commercial |
$1,178.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,581.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,740.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,210.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,457.62
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,443.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,443.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,852.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,825.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,095.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,696.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,012.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,725.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,443.75
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,825.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,696.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
|
