|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
915357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$231.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 B/E ACRYLIC
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
915357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.21
|
| Rate for Payer: Blue Shield of California Commercial |
$465.25
|
| Rate for Payer: Blue Shield of California Commercial |
$306.74
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$389.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
915357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.21
|
| Rate for Payer: Blue Shield of California Commercial |
$465.25
|
| Rate for Payer: Blue Shield of California Commercial |
$306.74
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$389.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
915357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.68
|
| Rate for Payer: Blue Shield of California Commercial |
$388.35
|
| Rate for Payer: Blue Shield of California Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
915357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.68
|
| Rate for Payer: Blue Shield of California Commercial |
$388.35
|
| Rate for Payer: Blue Shield of California Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
915357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$239.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$758.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$705.05
|
| 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 |
$776.75
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$239.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$758.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$705.05
|
| 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 |
$776.75
|
| 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 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 |
$723.33
|
| Rate for Payer: Blue Shield of California Commercial |
$918.96
|
| Rate for Payer: Blue Shield of California Commercial |
$605.87
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$769.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$758.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$869.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$705.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$836.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$836.50
|
| Rate for Payer: Multiplan Commercial |
$956.00
|
| Rate for Payer: Networks By Design Commercial |
$597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,015.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.48
|
| Rate for Payer: United Healthcare All Other HMO |
$436.53
|
| Rate for Payer: United Healthcare HMO Rider |
$427.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,015.75
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
915357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$1,015.75 |
| Rate for Payer: Adventist Health Commercial |
$489.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$657.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$723.33
|
| Rate for Payer: Blue Shield of California Commercial |
$918.96
|
| Rate for Payer: Blue Shield of California Commercial |
$605.87
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$769.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$758.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$869.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$705.05
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| 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 |
$396.50
|
| 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 |
915357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| 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 |
$396.50
|
| 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 |
$369.23
|
| Rate for Payer: Blue Shield of California Commercial |
$469.09
|
| Rate for Payer: Blue Shield of California Commercial |
$309.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| 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
|
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 |
$369.23
|
| Rate for Payer: Blue Shield of California Commercial |
$469.09
|
| Rate for Payer: Blue Shield of California Commercial |
$309.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.90
|
| 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 |
$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 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 |
$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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,290.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,799.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.22
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,511.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,290.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,799.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,459.22
|
| 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 |
$3,779.00
|
| 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 DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$167.34
|
| Rate for Payer: Blue Shield of California Commercial |
$253.01
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO |
$232.32
|
| Rate for Payer: Cigna of CA PPO |
$268.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC ADENOVIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$145.20
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.12
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
|
|
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 |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| 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 Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$153.05
|
| Rate for Payer: Blue Shield of California Commercial |
$126.31
|
| Rate for Payer: Blue Shield of California Commercial |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$190.98
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| 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 All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| 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 Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| 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
|
|
