|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$21,128.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$19,015.20 |
| Rate for Payer: Adventist Health Commercial |
$4,225.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Cash Price |
$9,507.60
|
| Rate for Payer: Cash Price |
$9,507.60
|
| Rate for Payer: Cash Price |
$9,507.60
|
| Rate for Payer: Cash Price |
$9,507.60
|
| Rate for Payer: Central Health Plan Commercial |
$16,902.40
|
| Rate for Payer: Cigna of CA HMO |
$13,521.92
|
| Rate for Payer: Cigna of CA PPO |
$15,634.72
|
| 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 |
$14,789.60
|
| 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 |
$17,958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$12,676.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,015.20
|
| 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 |
$13,416.28
|
| 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 |
$4,225.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$15,846.00
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$13,733.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Commercial |
$17,958.80
|
| Rate for Payer: Prime Health Services Medicare |
$11,964.44
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$12,415.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,676.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,564.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,564.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,564.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,564.00
|
| 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
|
$21,128.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4,225.60 |
| Max. Negotiated Rate |
$19,015.20 |
| Rate for Payer: Adventist Health Commercial |
$4,225.60
|
| Rate for Payer: Cash Price |
$9,507.60
|
| Rate for Payer: Central Health Plan Commercial |
$16,902.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,789.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,451.20
|
| Rate for Payer: Galaxy Health WC |
$17,958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$12,676.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,015.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,416.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,465.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,225.60
|
| Rate for Payer: Multiplan Commercial |
$15,846.00
|
| Rate for Payer: Networks By Design Commercial |
$13,733.20
|
| Rate for Payer: Prime Health Services Commercial |
$17,958.80
|
|
|
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 |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| 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 Exchange |
$50.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$66.57
|
| Rate for Payer: Blue Shield of California EPN |
$41.90
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| 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: Health Management Network EPO/PPO |
$94.50
|
| 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 |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Riverside University Health System MISP |
$42.00
|
| 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 |
915368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| 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 Exchange |
$50.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$66.57
|
| Rate for Payer: Blue Shield of California EPN |
$41.90
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| 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: Health Management Network EPO/PPO |
$94.50
|
| 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 |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Riverside University Health System MISP |
$42.00
|
| 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 |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| 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: Health Management Network EPO/PPO |
$94.50
|
| 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 |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| 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 |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| 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: Health Management Network EPO/PPO |
$94.50
|
| 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 |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| 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 |
915354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| 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 |
$13.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| 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: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.90
|
| 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 |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| 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 |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| 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: Health Management Network EPO/PPO |
$20.70
|
| 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 |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| 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 |
905354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$20.70 |
| 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 |
$13.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| 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: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.90
|
| 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 |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| 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 |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| 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: Health Management Network EPO/PPO |
$20.70
|
| 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 |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| 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 |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.99
|
| Rate for Payer: Blue Shield of California EPN |
$753.48
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| 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: Health Management Network EPO/PPO |
$1,345.50
|
| 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 |
$299.00
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| 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
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
915354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.99
|
| Rate for Payer: Blue Shield of California EPN |
$753.48
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| 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: Health Management Network EPO/PPO |
$1,345.50
|
| 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 |
$299.00
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| 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 |
$489.61 |
| Max. Negotiated Rate |
$1,345.50 |
| 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 |
$869.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.99
|
| Rate for Payer: Blue Shield of California EPN |
$753.48
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| 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: Health Management Network EPO/PPO |
$1,345.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$755.49
|
| 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 |
$612.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Riverside University Health System MISP |
$598.00
|
| 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 |
$489.61 |
| Max. Negotiated Rate |
$1,345.50 |
| 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 |
$869.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.99
|
| Rate for Payer: Blue Shield of California EPN |
$753.48
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| 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: Health Management Network EPO/PPO |
$1,345.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$755.49
|
| 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 |
$612.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Riverside University Health System MISP |
$598.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.07
|
| Rate for Payer: United Healthcare All Other HMO |
$546.12
|
| Rate for Payer: United Healthcare HMO Rider |
$534.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$12,708.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,541.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$5,718.60
|
| Rate for Payer: Cash Price |
$5,718.60
|
| Rate for Payer: Cash Price |
$5,718.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,166.40
|
| Rate for Payer: Cigna of CA HMO |
$8,133.12
|
| Rate for Payer: Cigna of CA PPO |
$9,403.92
|
| 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 |
$8,895.60
|
| 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 |
$10,801.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,624.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,437.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$568.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,069.58
|
| 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 |
$2,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,531.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,260.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$10,801.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,624.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,354.00
|
| 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 TUNNELED CV CATH
|
Facility
|
IP
|
$12,708.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,541.60 |
| Max. Negotiated Rate |
$11,437.20 |
| Rate for Payer: Adventist Health Commercial |
$2,541.60
|
| Rate for Payer: Cash Price |
$5,718.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,166.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,895.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,083.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,083.20
|
| Rate for Payer: Galaxy Health WC |
$10,801.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,624.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,437.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,069.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,497.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.60
|
| Rate for Payer: Multiplan Commercial |
$9,531.00
|
| Rate for Payer: Networks By Design Commercial |
$8,260.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,801.80
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$13,260.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$11,934.00 |
| Rate for Payer: Adventist Health Commercial |
$2,652.00
|
| Rate for Payer: Cash Price |
$5,967.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,608.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,282.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,304.00
|
| Rate for Payer: Galaxy Health WC |
$11,271.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,956.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,934.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,420.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,823.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,652.00
|
| Rate for Payer: Multiplan Commercial |
$9,945.00
|
| Rate for Payer: Networks By Design Commercial |
$8,619.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,271.00
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$13,260.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,652.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$5,967.00
|
| Rate for Payer: Cash Price |
$5,967.00
|
| Rate for Payer: Cash Price |
$5,967.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,608.00
|
| Rate for Payer: Cigna of CA HMO |
$8,486.40
|
| Rate for Payer: Cigna of CA PPO |
$9,812.40
|
| 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 |
$9,282.00
|
| 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 |
$11,271.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,956.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,934.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$568.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,420.10
|
| 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 |
$2,652.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,945.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,619.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$11,271.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,956.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,630.00
|
| 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 REPLANTATION DIGIT, COMPLETE
|
Facility
|
IP
|
$10,609.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,121.80 |
| Max. Negotiated Rate |
$9,548.10 |
| Rate for Payer: Adventist Health Commercial |
$2,121.80
|
| Rate for Payer: Cash Price |
$4,774.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,487.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,243.60
|
| Rate for Payer: Galaxy Health WC |
$9,017.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,548.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,736.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,259.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.80
|
| Rate for Payer: Multiplan Commercial |
$7,956.75
|
| Rate for Payer: Networks By Design Commercial |
$6,895.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,017.65
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
OP
|
$10,609.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,562.00 |
| Rate for Payer: Adventist Health Commercial |
$2,121.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$4,774.05
|
| Rate for Payer: Cash Price |
$4,774.05
|
| Rate for Payer: Cash Price |
$4,774.05
|
| Rate for Payer: Cash Price |
$4,774.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,487.20
|
| Rate for Payer: Cigna of CA HMO |
$6,789.76
|
| Rate for Payer: Cigna of CA PPO |
$7,850.66
|
| 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 |
$7,426.30
|
| 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 |
$9,017.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,548.10
|
| 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 |
$6,736.72
|
| 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 |
$2,121.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,956.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,895.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$9,017.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,304.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,304.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,304.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,304.50
|
| 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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$14,091.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,272.80
|
| Rate for Payer: Cigna of CA HMO |
$9,018.24
|
| Rate for Payer: Cigna of CA PPO |
$10,427.34
|
| 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 |
$9,863.70
|
| 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 |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,681.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,947.78
|
| 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 |
$2,818.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$10,568.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,454.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,045.50
|
| 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 CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$14,091.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,818.20 |
| Max. Negotiated Rate |
$12,681.90 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,272.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,636.40
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,681.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,947.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,313.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,818.20
|
| Rate for Payer: Multiplan Commercial |
$10,568.25
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$3,672.90 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,856.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,632.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,632.40
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,591.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,407.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$3,672.90 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,856.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,632.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,632.40
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,591.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,407.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: Cigna of CA HMO |
$2,611.84
|
| Rate for Payer: Cigna of CA PPO |
$3,019.94
|
| 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 |
$2,856.70
|
| 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 |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,591.43
|
| 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 |
$816.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,448.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.50
|
| 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
|
|
