|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$21,128.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$14,092.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,049.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,078.23
|
| 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 |
$61.67
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| 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: 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: InnovAge PACE Commercial |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$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: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
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 |
$61.67
|
| Rate for Payer: Blue Shield of California Commercial |
$64.16
|
| 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: 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: InnovAge PACE Commercial |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$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: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
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: 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 Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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: 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 Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$13.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.78
|
| 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: 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: InnovAge PACE Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$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
|
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: 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 |
$13.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.78
|
| 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: 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: InnovAge PACE Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$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 |
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 |
$17.78
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$17.78
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$1,155.63
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$1,155.63
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$878.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,155.63
|
| 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: 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: InnovAge PACE Commercial |
$747.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| 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 |
$878.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,155.63
|
| 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: 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: InnovAge PACE Commercial |
$747.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| 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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,541.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$568.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,476.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| 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 |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,624.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REPLACE 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: 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 Permanente of CA Commercial/Self Funded |
$8,476.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,841.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,866.25
|
| 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
|
$11,530.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,306.00 |
| Max. Negotiated Rate |
$10,377.00 |
| Rate for Payer: Adventist Health Commercial |
$2,306.00
|
| Rate for Payer: Cash Price |
$5,188.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,612.00
|
| Rate for Payer: Galaxy Health WC |
$9,800.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,690.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,392.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,137.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.00
|
| Rate for Payer: Multiplan Commercial |
$8,647.50
|
| Rate for Payer: Networks By Design Commercial |
$7,494.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,800.50
|
|
|
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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,652.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,271.00
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$568.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,652.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| 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 |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,956.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$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: 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 Permanente of CA Commercial/Self Funded |
$8,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,052.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,207.94
|
| 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
|
$11,530.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,306.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$5,188.50
|
| Rate for Payer: Cash Price |
$5,188.50
|
| Rate for Payer: Cash Price |
$5,188.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,224.00
|
| Rate for Payer: Cigna of CA HMO |
$7,379.20
|
| Rate for Payer: Cigna of CA PPO |
$8,532.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,800.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,377.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$568.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,690.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,647.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,494.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,800.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$7,076.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,042.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,566.97
|
| 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 |
$15,320.00 |
| 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 |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| 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 |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| 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 |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,076.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,626.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| 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 |
$2,033.48
|
| 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 |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| 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 |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$12,253.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,450.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,802.40
|
| Rate for Payer: Cigna of CA HMO |
$7,841.92
|
| Rate for Payer: Cigna of CA PPO |
$9,067.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,415.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,027.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,964.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$10,415.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,351.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$12,253.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,450.60 |
| Max. Negotiated Rate |
$11,027.70 |
| Rate for Payer: Adventist Health Commercial |
$2,450.60
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,901.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,901.20
|
| Rate for Payer: Galaxy Health WC |
$10,415.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,027.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,668.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,584.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.60
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
| Rate for Payer: Networks By Design Commercial |
$7,964.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,415.05
|
|
|
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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,818.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| 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 |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,454.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$9,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,368.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,722.33
|
| 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
|
|
