|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.12
|
| Rate for Payer: Multiplan Commercial |
$1,590.40
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.12 |
| Max. Negotiated Rate |
$1,689.80 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,151.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,467.14
|
| Rate for Payer: Blue Shield of California EPN |
$966.17
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,392.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,590.40
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.64 |
| Max. Negotiated Rate |
$1,492.94 |
| Rate for Payer: Adventist Health Commercial |
$609.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,114.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$860.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,096.67
|
| Rate for Payer: Blue Shield of California EPN |
$722.20
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,320.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,040.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,040.20
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.64
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$905.28 |
| Max. Negotiated Rate |
$3,206.20 |
| Rate for Payer: Adventist Health Commercial |
$1,546.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,074.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,829.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,184.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,783.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,833.19
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,206.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,206.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,320.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,334.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,640.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$3,017.60
|
| Rate for Payer: Networks By Design Commercial |
$1,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,206.20
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,334.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.28
|
| Rate for Payer: Multiplan Commercial |
$3,017.60
|
| Rate for Payer: Networks By Design Commercial |
$1,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,256.88 |
| Max. Negotiated Rate |
$4,451.45 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,033.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,864.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,545.18
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,285.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,665.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.88
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.88
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,256.88 |
| Max. Negotiated Rate |
$4,451.45 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,033.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,864.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,545.18
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,285.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,665.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$251.52 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.00
|
| Rate for Payer: Blue Shield of California Commercial |
$773.42
|
| Rate for Payer: Blue Shield of California EPN |
$509.33
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$251.52 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.00
|
| Rate for Payer: Blue Shield of California Commercial |
$773.42
|
| Rate for Payer: Blue Shield of California EPN |
$509.33
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,390.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,390.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.52 |
| Max. Negotiated Rate |
$5,332.05 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,633.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4,629.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,048.68
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,730.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,391.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.52 |
| Max. Negotiated Rate |
$5,332.05 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,633.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4,629.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,048.68
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,730.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,391.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
915358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
915358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.97
|
| Rate for Payer: Blue Shield of California Commercial |
$78.97
|
| Rate for Payer: Blue Shield of California EPN |
$52.00
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$183.31
|
| Rate for Payer: Blue Shield of California EPN |
$121.11
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Senior |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
