|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,798.56 |
| Max. Negotiated Rate |
$6,369.90 |
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,340.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,530.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,642.08
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,408.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,798.56 |
| Max. Negotiated Rate |
$6,369.90 |
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,340.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,530.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,642.08
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,408.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$6,047.75 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,121.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,250.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,457.89
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$6,047.75 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,121.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,250.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,457.89
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,241.84 |
| Max. Negotiated Rate |
$7,939.85 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,410.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6,893.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,539.73
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,241.84 |
| Max. Negotiated Rate |
$7,939.85 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,410.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6,893.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,539.73
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.92 |
| Max. Negotiated Rate |
$1,536.80 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.30
|
| Rate for Payer: Blue Shield of California EPN |
$878.69
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,054.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.92 |
| Max. Negotiated Rate |
$1,536.80 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.30
|
| Rate for Payer: Blue Shield of California EPN |
$878.69
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,054.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,112.24 |
| Max. Negotiated Rate |
$7,480.85 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,097.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,495.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,277.29
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,112.24 |
| Max. Negotiated Rate |
$7,480.85 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,097.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,495.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,277.29
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$2,180.30 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,180.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$761.60
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,178.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$3,970.60 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,970.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$908.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,027.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$761.60
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,178.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$6,265.15 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,265.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,361.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
