|
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
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
905357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$239.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$797.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.30
|
| 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: 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: 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
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
915357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$250.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.31
|
| Rate for Payer: Blue Shield of California Commercial |
$450.18
|
| Rate for Payer: Blue Shield of California EPN |
$296.46
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.93
|
| Rate for Payer: United Healthcare All Other HMO |
$222.83
|
| Rate for Payer: United Healthcare HMO Rider |
$218.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
915357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.93
|
| Rate for Payer: United Healthcare All Other HMO |
$222.83
|
| Rate for Payer: United Healthcare HMO Rider |
$218.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.78
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
905357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.93
|
| Rate for Payer: United Healthcare All Other HMO |
$222.83
|
| Rate for Payer: United Healthcare HMO Rider |
$218.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.78
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
905357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$250.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.31
|
| Rate for Payer: Blue Shield of California Commercial |
$450.18
|
| Rate for Payer: Blue Shield of California EPN |
$296.46
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.93
|
| Rate for Payer: United Healthcare All Other HMO |
$222.83
|
| Rate for Payer: United Healthcare HMO Rider |
$218.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC ADD UE WRST OR ELBW ULTRA FLEX
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
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 WRST OR ELBW ULTRA FLEX
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
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 VENOUS ABLATION SNGL EXTRE
|
Facility
|
IP
|
$7,558.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,511.60 |
| Max. Negotiated Rate |
$6,424.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.60
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.20
|
| Rate for Payer: Galaxy Health WC |
$6,424.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,879.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,813.92
|
| Rate for Payer: Multiplan Commercial |
$6,046.40
|
| Rate for Payer: Networks By Design Commercial |
$4,912.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,424.30
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
OP
|
$7,558.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,511.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,424.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,156.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,668.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cigna of CA HMO |
$4,837.12
|
| Rate for Payer: Cigna of CA PPO |
$5,592.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,424.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,424.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,424.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,023.20
|
| Rate for Payer: Galaxy Health WC |
$6,424.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,813.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,290.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,290.60
|
| Rate for Payer: Multiplan Commercial |
$6,046.40
|
| Rate for Payer: Networks By Design Commercial |
$4,912.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,424.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,424.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,424.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,424.30
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$183.31
|
| Rate for Payer: Blue Shield of California EPN |
$121.11
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.47
|
| Rate for Payer: Blue Shield of California Commercial |
$302.58
|
| Rate for Payer: Blue Shield of California EPN |
$199.26
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.47
|
| Rate for Payer: Blue Shield of California Commercial |
$302.58
|
| Rate for Payer: Blue Shield of California EPN |
$199.26
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
OP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.29
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$125.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.87
|
| Rate for Payer: Multiplan Commercial |
$135.86
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.91
|
| Rate for Payer: United Healthcare All Other HMO |
$84.91
|
| Rate for Payer: United Healthcare HMO Rider |
$84.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$144.35
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
IP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.76
|
| Rate for Payer: Multiplan Commercial |
$135.86
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
IP
|
$137.03
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Adventist Health Commercial |
$27.41
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.81
|
| Rate for Payer: EPIC Health Plan Senior |
$54.81
|
| Rate for Payer: Galaxy Health WC |
$116.48
|
| Rate for Payer: Global Benefits Group Commercial |
$82.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.89
|
| Rate for Payer: Multiplan Commercial |
$109.62
|
| Rate for Payer: Networks By Design Commercial |
$89.07
|
| Rate for Payer: Prime Health Services Commercial |
$116.48
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
OP
|
$137.03
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Adventist Health Commercial |
$27.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.15
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna of CA HMO |
$87.70
|
| Rate for Payer: Cigna of CA PPO |
$101.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.81
|
| Rate for Payer: EPIC Health Plan Senior |
$54.81
|
| Rate for Payer: Galaxy Health WC |
$116.48
|
| Rate for Payer: Global Benefits Group Commercial |
$82.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.92
|
| Rate for Payer: Multiplan Commercial |
$109.62
|
| Rate for Payer: Networks By Design Commercial |
$89.07
|
| Rate for Payer: Prime Health Services Commercial |
$116.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Other HMO |
$68.52
|
| Rate for Payer: United Healthcare HMO Rider |
$68.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.48
|
| Rate for Payer: Vantage Medical Group Senior |
$116.48
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
OP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.13
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.74
|
| Rate for Payer: Multiplan Commercial |
$52.28
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.67
|
| Rate for Payer: United Healthcare All Other HMO |
$32.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
IP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$52.28
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
IP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$98.52 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Multiplan Commercial |
$92.72
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
OP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$98.52 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.17
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cigna of CA HMO |
$74.18
|
| Rate for Payer: Cigna of CA PPO |
$85.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.13
|
| Rate for Payer: Multiplan Commercial |
$92.72
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Other HMO |
$57.95
|
| Rate for Payer: United Healthcare HMO Rider |
$57.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Vantage Medical Group Senior |
$98.52
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$7,809.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,561.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cigna of CA HMO |
$4,997.76
|
| Rate for Payer: Cigna of CA PPO |
$5,778.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,637.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,685.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$6,247.20
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$5,075.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,637.65
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,685.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,904.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,904.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,904.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,904.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
