|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,568.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,315.80
|
| 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 |
$3,653.00
|
| 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 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 |
$2,631.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,342.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,203.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,541.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,564.73
|
| 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
|
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 |
$2,631.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,342.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,203.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,541.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,564.73
|
| 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 |
915350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,760.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,564.73
|
| 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 |
$2,825.55
|
| 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 |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,760.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,564.73
|
| 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 |
$2,825.55
|
| 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 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 |
$101.69
|
| Rate for Payer: Blue Shield of California Commercial |
$85.18
|
| Rate for Payer: Blue Shield of California Commercial |
$129.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| 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 |
$101.69
|
| Rate for Payer: Blue Shield of California Commercial |
$85.18
|
| Rate for Payer: Blue Shield of California Commercial |
$129.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| 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
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| 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 |
$109.20
|
| 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 |
915351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| 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 |
$109.20
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.31
|
| 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 |
$460.85
|
| 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
|
IP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
915351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.31
|
| 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 |
$460.85
|
| 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 |
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 |
$429.16
|
| Rate for Payer: Blue Shield of California Commercial |
$545.22
|
| Rate for Payer: Blue Shield of California Commercial |
$359.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.31
|
| 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
|
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: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| 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 |
$429.16
|
| Rate for Payer: Blue Shield of California Commercial |
$545.22
|
| Rate for Payer: Blue Shield of California Commercial |
$359.46
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.31
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 |
$341.90
|
| 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
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
915351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 |
$341.90
|
| 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: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| 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 |
$318.39
|
| Rate for Payer: Blue Shield of California Commercial |
$404.49
|
| Rate for Payer: Blue Shield of California Commercial |
$266.68
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 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 |
$318.39
|
| Rate for Payer: Blue Shield of California Commercial |
$404.49
|
| Rate for Payer: Blue Shield of California Commercial |
$266.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
$172.25
|
| 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 |
915351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
$172.25
|
| 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 |
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 |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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
|
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: 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 |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
$172.25
|
| 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
|
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 |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
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 |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
905351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| 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 |
$172.25
|
| 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
|
|
