|
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 |
915351110
|
|
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
|
|
|
HC CTLSO STERNAL PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC CTLSO STERNAL PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
915351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC CTLSO STERNAL PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC CTLSO STERNAL PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
915351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC CTLSO THORACI PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
915351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC CTLSO THORACI PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
905351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC CTLSO THORACI PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
915351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC CTLSO THORACI PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
905351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC CTLSO TRAPEZE SLING
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
915351070
|
|
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 TRAPEZE SLING
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
915351070
|
|
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 |
$90.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.12
|
| 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 TRAPEZE SLING
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
905351070
|
|
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 TRAPEZE SLING
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
905351070
|
|
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 |
$90.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.12
|
| 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 UPRIGHT COVER EA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
905351120
|
|
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 UPRIGHT COVER EA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
915351120
|
|
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 UPRIGHT COVER EA
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
905351120
|
|
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 |
$53.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.59
|
| 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 UPRIGHT COVER EA
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
915351120
|
|
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 |
$53.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.59
|
| 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 W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,384.56 |
| Max. Negotiated Rate |
$4,903.65 |
| Rate for Payer: Adventist Health Commercial |
$2,365.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,326.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,341.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,257.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,803.73
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,903.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,903.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,038.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,165.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,107.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,061.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,889.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
915350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,384.56 |
| Max. Negotiated Rate |
$4,903.65 |
| Rate for Payer: Adventist Health Commercial |
$2,365.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,326.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,341.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,257.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,803.73
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,903.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,903.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,038.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,165.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,107.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,061.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,889.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
915350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,165.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,107.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,061.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,889.35
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,165.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,107.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,061.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,889.35
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$3,363.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,858.55 |
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,065.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,058.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,358.65
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cigna of CA HMO |
$2,152.32
|
| Rate for Payer: Cigna of CA PPO |
$2,488.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,858.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,017.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,243.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$807.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,690.40
|
| Rate for Payer: Networks By Design Commercial |
$2,185.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,858.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,017.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,017.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
IP
|
$6,323.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,264.60 |
| Max. Negotiated Rate |
$5,374.55 |
| Rate for Payer: Adventist Health Commercial |
$1,264.60
|
| Rate for Payer: Cash Price |
$2,845.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,529.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,529.20
|
| Rate for Payer: Galaxy Health WC |
$5,374.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,793.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,409.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,913.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.52
|
| Rate for Payer: Multiplan Commercial |
$5,058.40
|
| Rate for Payer: Networks By Design Commercial |
$4,109.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,374.55
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,494.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.00
|
| Rate for Payer: Blue Shield of California EPN |
$982.93
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,946.40
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
