|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$467.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.04
|
| Rate for Payer: Blue Shield of California Commercial |
$876.66
|
| Rate for Payer: Blue Shield of California Commercial |
$577.98
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$467.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.04
|
| Rate for Payer: Blue Shield of California Commercial |
$876.66
|
| Rate for Payer: Blue Shield of California Commercial |
$577.98
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.24 |
| Max. Negotiated Rate |
$1,063.35 |
| Rate for Payer: Adventist Health Commercial |
$512.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.23
|
| Rate for Payer: Blue Shield of California Commercial |
$962.02
|
| Rate for Payer: Blue Shield of California Commercial |
$634.26
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$1,000.80
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.24
|
| Rate for Payer: Multiplan Commercial |
$1,000.80
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
915355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.24
|
| Rate for Payer: Multiplan Commercial |
$1,000.80
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
915355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.24 |
| Max. Negotiated Rate |
$1,063.35 |
| Rate for Payer: Adventist Health Commercial |
$512.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.23
|
| Rate for Payer: Blue Shield of California Commercial |
$962.02
|
| Rate for Payer: Blue Shield of California Commercial |
$634.26
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$1,000.80
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC ADD PYLON W/INTGRTD ELECT FORC
|
Facility
|
IP
|
$9,277.00
|
|
| Hospital Charge Code |
905355989
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,855.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,855.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cigna of CA HMO |
$6,493.90
|
| Rate for Payer: Cigna of CA PPO |
$6,493.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,493.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,710.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,710.80
|
| Rate for Payer: Galaxy Health WC |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,890.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,473.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.48
|
| Rate for Payer: Multiplan Commercial |
$7,421.60
|
| Rate for Payer: Networks By Design Commercial |
$6,030.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,481.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3,388.89
|
| Rate for Payer: United Healthcare HMO Rider |
$3,315.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,038.22
|
|
|
HC ADD PYLON W/INTGRTD ELECT FORC
|
Facility
|
OP
|
$9,277.00
|
|
| Hospital Charge Code |
905355989
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,226.48 |
| Max. Negotiated Rate |
$7,885.45 |
| Rate for Payer: Adventist Health Commercial |
$3,803.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,102.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,957.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,615.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4,703.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,134.01
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cigna of CA HMO |
$6,493.90
|
| Rate for Payer: Cigna of CA PPO |
$6,493.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,885.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,885.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,493.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,710.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,710.80
|
| Rate for Payer: Galaxy Health WC |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,890.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,367.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,473.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,493.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,493.90
|
| Rate for Payer: Multiplan Commercial |
$7,421.60
|
| Rate for Payer: Networks By Design Commercial |
$4,638.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,566.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,566.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,481.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3,388.89
|
| Rate for Payer: United Healthcare HMO Rider |
$3,315.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,038.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,885.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,885.45
|
|
|
HC ADD QCK CHNG DEV AK/BK
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
905355817
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Adventist Health Commercial |
$108.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: EPIC Health Plan Senior |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$320.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
|
HC ADD QCK CHNG DEV AK/BK
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
905355817
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Adventist Health Commercial |
$108.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.08
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$348.16
|
| Rate for Payer: Cigna of CA PPO |
$402.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: EPIC Health Plan Senior |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$320.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$380.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$380.80
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.00
|
| Rate for Payer: United Healthcare All Other HMO |
$272.00
|
| Rate for Payer: United Healthcare HMO Rider |
$272.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.40
|
| Rate for Payer: Vantage Medical Group Senior |
$462.40
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
IP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Networks By Design Commercial |
$310.70
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Adventist Health Commercial |
$195.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.33
|
| Rate for Payer: Blue Shield of California Commercial |
$242.35
|
| Rate for Payer: Blue Shield of California Commercial |
$367.58
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$303.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.60
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
|
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 |
$1,897.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,589.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,990.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,849.65
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,990.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,849.65
|
| 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 |
$2,037.75
|
| 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
|
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 |
$397.68
|
| Rate for Payer: Blue Shield of California Commercial |
$333.10
|
| Rate for Payer: Blue Shield of California Commercial |
$505.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$238.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$387.63
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$387.63
|
| 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 |
$427.05
|
| 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 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 |
$662.80
|
| Rate for Payer: Blue Shield of California Commercial |
$842.05
|
| Rate for Payer: Blue Shield of California Commercial |
$555.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$665.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| 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
|
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 |
$662.80
|
| Rate for Payer: Blue Shield of California Commercial |
$842.05
|
| Rate for Payer: Blue Shield of California Commercial |
$555.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$665.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| 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 |
905357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| 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 |
$711.75
|
| 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
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
915357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| 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 |
$711.75
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| 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 |
$367.25
|
| 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: 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 |
$341.99
|
| Rate for Payer: Blue Shield of California Commercial |
$434.49
|
| Rate for Payer: Blue Shield of California Commercial |
$286.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$410.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| 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 |
$367.25
|
| 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
|
|
