|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.83
|
| Rate for Payer: Blue Shield of California Commercial |
$119.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.73
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.83
|
| Rate for Payer: Blue Shield of California Commercial |
$119.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.73
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
915351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.57
|
| Rate for Payer: Blue Shield of California Commercial |
$270.85
|
| Rate for Payer: Blue Shield of California EPN |
$178.36
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
915351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.57
|
| Rate for Payer: Blue Shield of California Commercial |
$270.85
|
| Rate for Payer: Blue Shield of California EPN |
$178.36
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
905351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,133.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,466.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,800.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
915351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,133.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,466.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,800.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
915351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,344.00 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Adventist Health Commercial |
$2,296.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,080.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,243.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,132.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,721.60
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,760.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,466.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,920.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,920.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,800.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,760.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,760.00
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
905351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,344.00 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Adventist Health Commercial |
$2,296.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,080.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,243.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,132.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,721.60
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,760.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,466.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,920.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,920.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,800.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,760.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,760.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,760.00
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
915351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.31
|
| Rate for Payer: Blue Shield of California Commercial |
$138.01
|
| Rate for Payer: Blue Shield of California EPN |
$90.88
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
905351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
905351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.31
|
| Rate for Payer: Blue Shield of California Commercial |
$138.01
|
| Rate for Payer: Blue Shield of California EPN |
$90.88
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
915351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
915351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$140.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.09
|
| Rate for Payer: Blue Shield of California Commercial |
$252.40
|
| Rate for Payer: Blue Shield of California EPN |
$166.21
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$290.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Senior |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$239.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$239.40
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other HMO |
$124.93
|
| Rate for Payer: United Healthcare HMO Rider |
$122.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.70
|
| Rate for Payer: Vantage Medical Group Senior |
$290.70
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
915351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Senior |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.08
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other HMO |
$124.93
|
| Rate for Payer: United Healthcare HMO Rider |
$122.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
905351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$140.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.09
|
| Rate for Payer: Blue Shield of California Commercial |
$252.40
|
| Rate for Payer: Blue Shield of California EPN |
$166.21
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$290.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Senior |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$239.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$239.40
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other HMO |
$124.93
|
| Rate for Payer: United Healthcare HMO Rider |
$122.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.70
|
| Rate for Payer: Vantage Medical Group Senior |
$290.70
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
905351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Senior |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.08
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other HMO |
$124.93
|
| Rate for Payer: United Healthcare HMO Rider |
$122.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
915351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
915351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
905351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
905351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC CTLSO LUMBAR RIB PAD
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
905351040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
|
