|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$1,076.10 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$886.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: EPIC Health Plan Senior |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.93 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO |
$1,809.92
|
| Rate for Payer: Cigna of CA PPO |
$2,092.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$547.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$807.71
|
| Rate for Payer: Blue Shield of California Commercial |
$532.99
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$886.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$799.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$904.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$1,076.10 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$886.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: EPIC Health Plan Senior |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$896.75 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$738.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$622.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Multiplan Commercial |
$844.00
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$638.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$673.09
|
| Rate for Payer: Blue Shield of California Commercial |
$444.15
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cigna of CA HMO |
$675.20
|
| Rate for Payer: Cigna of CA PPO |
$780.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$738.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$362.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$410.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$844.00
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$527.50
|
| Rate for Payer: United Healthcare All Other HMO |
$527.50
|
| Rate for Payer: United Healthcare HMO Rider |
$527.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$527.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
905358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.39
|
| Rate for Payer: Blue Shield of California Commercial |
$375.27
|
| Rate for Payer: Blue Shield of California Commercial |
$247.42
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
915358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.39
|
| Rate for Payer: Blue Shield of California Commercial |
$375.27
|
| Rate for Payer: Blue Shield of California Commercial |
$247.42
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
905358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
915358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$317.20
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
905358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.08 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Adventist Health Commercial |
$334.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$612.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.53
|
| Rate for Payer: Blue Shield of California Commercial |
$628.27
|
| Rate for Payer: Blue Shield of California Commercial |
$414.22
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$694.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$694.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$694.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$518.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$694.45
|
| Rate for Payer: Vantage Medical Group Senior |
$694.45
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
905358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$163.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$518.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$531.05
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
915358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.08 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Adventist Health Commercial |
$334.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$612.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.53
|
| Rate for Payer: Blue Shield of California Commercial |
$628.27
|
| Rate for Payer: Blue Shield of California Commercial |
$414.22
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$694.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$694.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$694.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$518.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$694.45
|
| Rate for Payer: Vantage Medical Group Senior |
$694.45
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
915358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$163.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$518.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$531.05
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
|
|
HC BREAST PROSTHESIS
|
Facility
|
IP
|
$8,525.00
|
|
|
Service Code
|
CPT L8039
|
| Hospital Charge Code |
905358039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cigna of CA HMO |
$5,967.50
|
| Rate for Payer: Cigna of CA PPO |
$5,967.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,967.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,410.00
|
| Rate for Payer: Galaxy Health WC |
$7,246.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,115.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,413.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,029.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.00
|
| Rate for Payer: Multiplan Commercial |
$6,820.00
|
| Rate for Payer: Networks By Design Commercial |
$5,541.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,246.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,199.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,114.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,046.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.94
|
|
|
HC BREAST PROSTHESIS
|
Facility
|
OP
|
$8,525.00
|
|
|
Service Code
|
CPT L8039
|
| Hospital Charge Code |
905358039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,046.00 |
| Max. Negotiated Rate |
$7,246.25 |
| Rate for Payer: Multiplan Commercial |
$6,820.00
|
| Rate for Payer: Networks By Design Commercial |
$4,262.50
|
| Rate for Payer: Adventist Health Commercial |
$3,495.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,688.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,160.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,322.18
|
| Rate for Payer: Blue Shield of California Commercial |
$6,555.73
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cigna of CA HMO |
$5,967.50
|
| Rate for Payer: Cigna of CA PPO |
$5,967.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,246.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,246.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,967.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,410.00
|
| Rate for Payer: Galaxy Health WC |
$7,246.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,115.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,413.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,094.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,029.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,967.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,967.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,246.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,115.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,115.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,199.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,114.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,046.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,246.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,246.25
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
IP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
915358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.62 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$635.76
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
OP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
915358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$831.38 |
| Rate for Payer: Adventist Health Commercial |
$401.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$733.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.04
|
| Rate for Payer: Blue Shield of California Commercial |
$495.90
|
| Rate for Payer: Blue Shield of California Commercial |
$752.16
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$831.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$831.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.67
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$831.38
|
| Rate for Payer: Vantage Medical Group Senior |
$831.38
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
IP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
905358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.62 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$635.76
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
OP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
905358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$831.38 |
| Rate for Payer: Adventist Health Commercial |
$401.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$733.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.04
|
| Rate for Payer: Blue Shield of California Commercial |
$495.90
|
| Rate for Payer: Blue Shield of California Commercial |
$752.16
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$831.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$831.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.67
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$831.38
|
| Rate for Payer: Vantage Medical Group Senior |
$831.38
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
905358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$282.10
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
915358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$282.10
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
915358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$368.90 |
| Rate for Payer: Adventist Health Commercial |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.70
|
| Rate for Payer: Blue Shield of California Commercial |
$333.75
|
| Rate for Payer: Blue Shield of California Commercial |
$220.04
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.80
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.90
|
| Rate for Payer: Vantage Medical Group Senior |
$368.90
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
905358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$368.90 |
| Rate for Payer: Adventist Health Commercial |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.70
|
| Rate for Payer: Blue Shield of California Commercial |
$333.75
|
| Rate for Payer: Blue Shield of California Commercial |
$220.04
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.80
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.90
|
| Rate for Payer: Vantage Medical Group Senior |
$368.90
|
|
