|
HC ADD SYMES SKT INSERT SILICONE
|
Facility
|
OP
|
$2,438.00
|
|
|
Service Code
|
CPT L5660
|
| Hospital Charge Code |
905355660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$585.12 |
| Max. Negotiated Rate |
$2,072.30 |
| Rate for Payer: Adventist Health Commercial |
$999.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,340.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,828.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,799.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,184.87
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna of CA HMO |
$1,706.60
|
| Rate for Payer: Cigna of CA PPO |
$1,706.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,072.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,072.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$975.20
|
| Rate for Payer: Galaxy Health WC |
$2,072.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,509.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,706.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,706.60
|
| Rate for Payer: Multiplan Commercial |
$1,950.40
|
| Rate for Payer: Networks By Design Commercial |
$1,219.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,072.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,462.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,462.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.98
|
| Rate for Payer: United Healthcare All Other HMO |
$890.60
|
| Rate for Payer: United Healthcare HMO Rider |
$871.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$798.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,072.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,072.30
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$714.84 |
| Max. Negotiated Rate |
$2,664.75 |
| Rate for Payer: Adventist Health Commercial |
$1,285.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,815.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,313.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.61
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,194.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,508.00
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Multiplan Commercial |
$2,508.00
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$714.84 |
| Max. Negotiated Rate |
$2,664.75 |
| Rate for Payer: Adventist Health Commercial |
$1,285.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,815.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,313.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.61
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,194.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,508.00
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Multiplan Commercial |
$2,508.00
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
|
|
HC ADD TO LE ULTRAFLEX KNEE/ANKLE
|
Facility
|
IP
|
$657.00
|
|
| Hospital Charge Code |
905352860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.68
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.17
|
|
|
HC ADD TO LE ULTRAFLEX KNEE/ANKLE
|
Facility
|
OP
|
$657.00
|
|
| Hospital Charge Code |
905352860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.68 |
| Max. Negotiated Rate |
$558.45 |
| Rate for Payer: Adventist Health Commercial |
$269.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.53
|
| Rate for Payer: Blue Shield of California Commercial |
$484.87
|
| Rate for Payer: Blue Shield of California EPN |
$319.30
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$459.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$459.90
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
905357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.95
|
| Rate for Payer: United Healthcare All Other HMO |
$400.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.61
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
915357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$448.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$634.22
|
| Rate for Payer: Blue Shield of California Commercial |
$808.11
|
| Rate for Payer: Blue Shield of California EPN |
$532.17
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.95
|
| Rate for Payer: United Healthcare All Other HMO |
$400.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
915357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.95
|
| Rate for Payer: United Healthcare All Other HMO |
$400.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.61
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
905357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$448.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$634.22
|
| Rate for Payer: Blue Shield of California Commercial |
$808.11
|
| Rate for Payer: Blue Shield of California EPN |
$532.17
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.95
|
| Rate for Payer: United Healthcare All Other HMO |
$400.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
915357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$231.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.25
|
| Rate for Payer: Blue Shield of California Commercial |
$416.97
|
| Rate for Payer: Blue Shield of California EPN |
$274.59
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.50
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
915357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
905357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Adventist Health Commercial |
$231.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.25
|
| Rate for Payer: Blue Shield of California Commercial |
$416.97
|
| Rate for Payer: Blue Shield of California EPN |
$274.59
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.50
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
905357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
915357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.42
|
| Rate for Payer: Blue Shield of California Commercial |
$446.49
|
| Rate for Payer: Blue Shield of California EPN |
$294.03
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
915357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.42
|
| Rate for Payer: Blue Shield of California Commercial |
$446.49
|
| Rate for Payer: Blue Shield of California EPN |
$294.03
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$389.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
915357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.50
|
| Rate for Payer: Blue Shield of California Commercial |
$372.69
|
| Rate for Payer: Blue Shield of California EPN |
$245.43
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
915357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.50
|
| Rate for Payer: Blue Shield of California Commercial |
$372.69
|
| Rate for Payer: Blue Shield of California EPN |
$245.43
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
905357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$1,015.75 |
| Rate for Payer: Adventist Health Commercial |
$489.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$657.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$692.14
|
| Rate for Payer: Blue Shield of California Commercial |
$881.91
|
| Rate for Payer: Blue Shield of California EPN |
$580.77
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cigna of CA HMO |
$836.50
|
| Rate for Payer: Cigna of CA PPO |
$836.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,015.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,015.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.00
|
| Rate for Payer: EPIC Health Plan Senior |
$478.00
|
| Rate for Payer: Galaxy Health WC |
$1,015.75
|
| Rate for Payer: Global Benefits Group Commercial |
$717.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$769.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$797.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$869.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$739.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$836.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$836.50
|
| Rate for Payer: Multiplan Commercial |
$956.00
|
| Rate for Payer: Networks By Design Commercial |
$597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,015.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.48
|
| Rate for Payer: United Healthcare All Other HMO |
$436.53
|
| Rate for Payer: United Healthcare HMO Rider |
$427.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,015.75
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
915357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$1,015.75 |
| Rate for Payer: Adventist Health Commercial |
$489.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$657.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$692.14
|
| Rate for Payer: Blue Shield of California Commercial |
$881.91
|
| Rate for Payer: Blue Shield of California EPN |
$580.77
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cigna of CA HMO |
$836.50
|
| Rate for Payer: Cigna of CA PPO |
$836.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,015.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,015.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.00
|
| Rate for Payer: EPIC Health Plan Senior |
$478.00
|
| Rate for Payer: Galaxy Health WC |
$1,015.75
|
| Rate for Payer: Global Benefits Group Commercial |
$717.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$769.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$797.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$869.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$739.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$836.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$836.50
|
| Rate for Payer: Multiplan Commercial |
$956.00
|
| Rate for Payer: Networks By Design Commercial |
$597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,015.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.48
|
| Rate for Payer: United Healthcare All Other HMO |
$436.53
|
| Rate for Payer: United Healthcare HMO Rider |
$427.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,015.75
|
|
