|
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
|
|
|
HC CTLSO LUMBAR RIB PAD
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
905351040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| 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: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.22
|
| 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: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC CTLSO LUMBAR RIB PAD
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
915351040
|
|
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
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.66
|
| Rate for Payer: Blue Shield of California Commercial |
$225.09
|
| Rate for Payer: Blue Shield of California EPN |
$148.23
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
915351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
915351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.66
|
| Rate for Payer: Blue Shield of California Commercial |
$225.09
|
| Rate for Payer: Blue Shield of California EPN |
$148.23
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,141.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Multiplan Commercial |
$4,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
915351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,141.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Multiplan Commercial |
$4,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.80 |
| Max. Negotiated Rate |
$4,777.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,091.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,255.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,147.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,731.32
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,777.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,116.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,934.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,934.00
|
| Rate for Payer: Multiplan Commercial |
$4,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.00
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
915351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.80 |
| Max. Negotiated Rate |
$4,777.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,091.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,255.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,147.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,731.32
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,777.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,116.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,934.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,934.00
|
| Rate for Payer: Multiplan Commercial |
$4,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.00
|
|
|
HC CTLSO MINERVA
|
Facility
|
OP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,043.28 |
| Max. Negotiated Rate |
$3,694.95 |
| Rate for Payer: Adventist Health Commercial |
$1,782.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,390.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,517.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,208.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,112.64
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,694.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,694.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,541.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,042.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,042.90
|
| Rate for Payer: Multiplan Commercial |
$3,477.60
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,694.95
|
|
|
HC CTLSO MINERVA
|
Facility
|
IP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.28
|
| Rate for Payer: Multiplan Commercial |
$3,477.60
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
|
|
HC CTLSO MINERVA
|
Facility
|
IP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
915350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.28
|
| Rate for Payer: Multiplan Commercial |
$3,477.60
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
|
|
HC CTLSO MINERVA
|
Facility
|
OP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
915350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,043.28 |
| Max. Negotiated Rate |
$3,694.95 |
| Rate for Payer: Adventist Health Commercial |
$1,782.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,390.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,517.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,208.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,112.64
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,694.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,694.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,541.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,042.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,042.90
|
| Rate for Payer: Multiplan Commercial |
$3,477.60
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,694.95
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
915351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.31
|
| Rate for Payer: Blue Shield of California Commercial |
$123.98
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
915351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.31
|
| Rate for Payer: Blue Shield of California Commercial |
$123.98
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
905351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$290.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$389.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$531.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.65
|
| Rate for Payer: Blue Shield of California Commercial |
$523.24
|
| Rate for Payer: Blue Shield of California EPN |
$344.57
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$602.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$602.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$602.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.30
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.65
|
| Rate for Payer: Vantage Medical Group Senior |
$602.65
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
905351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
915351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$290.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$389.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$531.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.65
|
| Rate for Payer: Blue Shield of California Commercial |
$523.24
|
| Rate for Payer: Blue Shield of California EPN |
$344.57
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$602.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$602.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$602.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.30
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.65
|
| Rate for Payer: Vantage Medical Group Senior |
$602.65
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
915351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
905351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
905351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Adventist Health Commercial |
$215.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.66
|
| Rate for Payer: Blue Shield of California Commercial |
$388.19
|
| Rate for Payer: Blue Shield of California EPN |
$255.64
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$368.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$368.20
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
