|
HC PROPORT CNTR 12 VOLT UTAH
|
Facility
|
OP
|
$18,471.00
|
|
|
Service Code
|
CPT L7274
|
| Hospital Charge Code |
905357274
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,433.04 |
| Max. Negotiated Rate |
$15,700.35 |
| Rate for Payer: Adventist Health Commercial |
$7,573.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,853.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,631.60
|
| Rate for Payer: Blue Shield of California EPN |
$8,976.91
|
| Rate for Payer: Cash Price |
$10,159.05
|
| Rate for Payer: Cigna of CA HMO |
$12,929.70
|
| Rate for Payer: Cigna of CA PPO |
$12,929.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,700.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,700.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,388.40
|
| Rate for Payer: Galaxy Health WC |
$15,700.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,037.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,433.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,433.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,929.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,929.70
|
| Rate for Payer: Multiplan Commercial |
$14,776.80
|
| Rate for Payer: Networks By Design Commercial |
$9,235.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,700.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,082.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,082.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,932.17
|
| Rate for Payer: United Healthcare All Other HMO |
$6,747.46
|
| Rate for Payer: United Healthcare HMO Rider |
$6,601.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,049.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,700.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,700.35
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.09
|
| Rate for Payer: Blue Shield of California EPN |
$988.52
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.09
|
| Rate for Payer: Blue Shield of California EPN |
$988.52
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.66
|
| Rate for Payer: Blue Shield of California Commercial |
$998.51
|
| Rate for Payer: Blue Shield of California EPN |
$657.56
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.66
|
| Rate for Payer: Blue Shield of California Commercial |
$998.51
|
| Rate for Payer: Blue Shield of California EPN |
$657.56
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cash Price |
$744.15
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,709.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,125.58
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,709.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,125.58
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,496.88 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,496.88 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$216.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.40
|
| Rate for Payer: Blue Shield of California Commercial |
$390.40
|
| Rate for Payer: Blue Shield of California EPN |
$257.09
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Senior |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,278.99 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$619.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,278.99
|
| Rate for Payer: Blue Shield of California Commercial |
$632.21
|
| Rate for Payer: Blue Shield of California EPN |
$417.69
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$575.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
