|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$685.30 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,076.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$948.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.79
|
| Rate for Payer: Blue Distinction Transplant |
$1,174.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,468.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,065.15
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Media |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,468.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$685.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.78
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Riverside University Health System MISP |
$783.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,045.57
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.34
|
| Rate for Payer: United Healthcare All Other HMO |
$722.11
|
| Rate for Payer: United Healthcare HMO Rider |
$706.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.14
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$15,976.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,414.74 |
| Max. Negotiated Rate |
$14,378.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,323.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,585.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,048.90
|
| Rate for Payer: Blue Shield of California EPN |
$7,812.26
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,780.80
|
| Rate for Payer: Cigna of CA HMO |
$10,224.64
|
| Rate for Payer: Cigna of CA PPO |
$11,822.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$13,579.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,585.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,378.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,982.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,733.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: InnovAge PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$11,982.00
|
| Rate for Payer: Networks By Design Commercial |
$10,384.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,579.60
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Riverside University Health System MISP |
$9,155.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,585.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,585.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,988.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,988.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,988.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,988.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$15,976.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,195.20 |
| Max. Negotiated Rate |
$14,378.40 |
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,780.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,390.40
|
| Rate for Payer: Galaxy Health WC |
$13,579.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,585.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,378.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,086.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,195.20
|
| Rate for Payer: Multiplan Commercial |
$11,982.00
|
| Rate for Payer: Networks By Design Commercial |
$10,384.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,579.60
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$15,976.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$3,195.20 |
| Max. Negotiated Rate |
$14,378.40 |
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,780.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,390.40
|
| Rate for Payer: Galaxy Health WC |
$13,579.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,585.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,378.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,086.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,195.20
|
| Rate for Payer: Multiplan Commercial |
$11,982.00
|
| Rate for Payer: Networks By Design Commercial |
$10,384.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,579.60
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$15,976.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,378.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,378.77
|
| Rate for Payer: Blue Distinction Transplant |
$9,585.60
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Cash Price |
$7,189.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,780.80
|
| Rate for Payer: Cigna of CA PPO |
$11,822.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$13,579.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,585.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,378.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,982.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: InnovAge PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$11,982.00
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$10,384.40
|
| Rate for Payer: Preferred Health Network WC |
$11,610.99
|
| Rate for Payer: Prime Health Services Commercial |
$13,579.60
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Riverside University Health System MISP |
$9,155.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,585.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,988.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,988.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,988.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,988.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
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: Blue Shield of California EPN |
$12.28
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$4.60
|
| 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: United Healthcare All Other Commercial |
$8.68
|
| Rate for Payer: United Healthcare All Other HMO |
$8.48
|
| Rate for Payer: United Healthcare HMO Rider |
$8.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.59
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
905354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$20.70 |
| 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 |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.59
|
| Rate for Payer: Blue Distinction Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.51
|
| 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 Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| 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: LLUH Dept of Risk Management WC |
$9.43
|
| 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 |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
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: Blue Shield of California EPN |
$798.33
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$299.00
|
| 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: United Healthcare All Other Commercial |
$564.51
|
| Rate for Payer: United Healthcare All Other HMO |
$551.36
|
| Rate for Payer: United Healthcare HMO Rider |
$539.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.35
|
|
|
HC REPLACE TRILAT SOCKET
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT L4010
|
| Hospital Charge Code |
905354010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$523.25 |
| Max. Negotiated Rate |
$1,345.50 |
| 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 |
$822.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$723.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$883.25
|
| Rate for Payer: Blue Distinction Transplant |
$897.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,121.25
|
| Rate for Payer: Blue Shield of California EPN |
$813.28
|
| 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 Media |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,121.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$523.25
|
| 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: LLUH Dept of Risk Management WC |
$612.95
|
| 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 |
$747.50
|
| Rate for Payer: United Healthcare All Other HMO |
$747.50
|
| Rate for Payer: United Healthcare HMO Rider |
$747.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$747.50
|
| 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
|
$11,632.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.53 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,979.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,234.40
|
| Rate for Payer: Cash Price |
$5,234.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,305.60
|
| Rate for Payer: Cigna of CA PPO |
$8,607.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,887.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,979.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,468.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,724.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,758.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,326.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,724.00
|
| Rate for Payer: Networks By Design Commercial |
$7,560.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,887.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$11,632.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,326.40 |
| Max. Negotiated Rate |
$10,468.80 |
| Rate for Payer: Cash Price |
$5,234.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,652.80
|
| Rate for Payer: Galaxy Health WC |
$9,887.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,979.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,468.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,758.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,431.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,326.40
|
| Rate for Payer: Multiplan Commercial |
$8,724.00
|
| Rate for Payer: Networks By Design Commercial |
$7,560.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,887.20
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,005.20 |
| Max. Negotiated Rate |
$9,023.40 |
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Galaxy Health WC |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,023.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,819.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.20
|
| Rate for Payer: Multiplan Commercial |
$7,519.50
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.53 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,015.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,020.80
|
| Rate for Payer: Cigna of CA PPO |
$7,419.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,023.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,519.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,519.50
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,015.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,005.20 |
| Max. Negotiated Rate |
$9,023.40 |
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Galaxy Health WC |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,023.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,819.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.20
|
| Rate for Payer: Multiplan Commercial |
$7,519.50
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.53 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,015.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,020.80
|
| Rate for Payer: Cigna of CA PPO |
$7,419.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,023.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,519.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,519.50
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,015.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
OP
|
$8,022.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,389.00 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,813.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$3,609.90
|
| Rate for Payer: Cash Price |
$3,609.90
|
| Rate for Payer: Cash Price |
$3,609.90
|
| Rate for Payer: Cash Price |
$3,609.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,417.60
|
| Rate for Payer: Cigna of CA PPO |
$5,936.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$6,818.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,813.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,219.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,016.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,626.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,016.50
|
| Rate for Payer: Networks By Design Commercial |
$5,214.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,818.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,813.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,011.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,011.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,011.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
IP
|
$8,022.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$7,219.80 |
| Rate for Payer: Cash Price |
$3,609.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,417.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,208.80
|
| Rate for Payer: Galaxy Health WC |
$6,818.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,813.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,219.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,056.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.40
|
| Rate for Payer: Multiplan Commercial |
$6,016.50
|
| Rate for Payer: Networks By Design Commercial |
$5,214.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,818.70
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$9,589.50 |
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,524.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,262.00
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,589.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.00
|
| Rate for Payer: Multiplan Commercial |
$7,991.25
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,524.00
|
| Rate for Payer: Cigna of CA PPO |
$7,884.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,589.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,991.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,991.25
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,524.00
|
| Rate for Payer: Cigna of CA PPO |
$7,884.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,589.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,991.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,991.25
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$9,589.50 |
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,524.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,262.00
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,589.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.00
|
| Rate for Payer: Multiplan Commercial |
$7,991.25
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$3,736.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$3,362.40 |
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,362.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.20
|
| Rate for Payer: Multiplan Commercial |
$2,802.00
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$3,736.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.55 |
| Max. Negotiated Rate |
$3,362.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,241.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$2,764.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,362.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,802.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,802.00
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,241.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,868.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$3,736.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.55 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,241.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$2,764.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,362.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,802.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,802.00
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,241.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
