|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| 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 |
$182.00
|
| 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 |
$169.48
|
| Rate for Payer: Blue Shield of California Commercial |
$215.32
|
| Rate for Payer: Blue Shield of California Commercial |
$141.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| 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
|
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 |
$169.48
|
| Rate for Payer: Blue Shield of California Commercial |
$215.32
|
| Rate for Payer: Blue Shield of California Commercial |
$141.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| 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 |
$182.00
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| 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 |
$121.55
|
| 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 |
$113.19
|
| Rate for Payer: Blue Shield of California Commercial |
$94.81
|
| Rate for Payer: Blue Shield of California Commercial |
$143.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| 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 |
$113.19
|
| Rate for Payer: Blue Shield of California Commercial |
$94.81
|
| Rate for Payer: Blue Shield of California Commercial |
$143.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| 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
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
905351120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| 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 |
$121.55
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,403.71
|
| 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 |
$3,749.85
|
| 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
|
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 |
$3,491.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,436.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,924.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,403.71
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,403.71
|
| 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 |
$3,749.85
|
| 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
|
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 |
$3,491.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,436.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,924.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,403.71
|
| 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 CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$6,323.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,374.55 |
| Rate for Payer: Adventist Health Commercial |
$1,264.60
|
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,057.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,158.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,415.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,145.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,661.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,034.07
|
| Rate for Payer: Cash Price |
$2,845.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$2,845.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$2,845.35
|
| Rate for Payer: Cigna of CA HMO |
$2,152.32
|
| Rate for Payer: Cigna of CA HMO |
$4,046.72
|
| Rate for Payer: Cigna of CA PPO |
$2,488.62
|
| Rate for Payer: Cigna of CA PPO |
$4,679.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,354.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,426.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$5,374.55
|
| Rate for Payer: Galaxy Health WC |
$2,858.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,793.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,017.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,015.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,135.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$807.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,690.40
|
| Rate for Payer: Multiplan Commercial |
$5,058.40
|
| Rate for Payer: Networks By Design Commercial |
$4,109.95
|
| Rate for Payer: Networks By Design Commercial |
$2,185.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,858.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,374.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,793.80
|
| 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: TriValley Medical Group Commercial/Senior |
$3,793.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,681.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,161.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,161.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,161.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,161.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,426.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,015.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,730.57
|
| 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
|
IP
|
$5,480.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,096.00 |
| Max. Negotiated Rate |
$4,658.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,192.00
|
| Rate for Payer: Galaxy Health WC |
$4,658.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,288.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,479.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,233.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.20
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Networks By Design Commercial |
$3,562.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,658.00
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$4,658.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.00
|
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,516.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,561.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,024.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,552.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,307.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,496.24
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA HMO |
$3,507.20
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| Rate for Payer: Cigna of CA PPO |
$4,055.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,703.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,658.00
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,288.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,479.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,946.40
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Networks By Design Commercial |
$3,562.00
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,658.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,288.00
|
| 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: TriValley Medical Group Commercial/Senior |
$3,288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,740.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,740.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
IP
|
$4,785.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$4,067.25 |
| Rate for Payer: Adventist Health Commercial |
$957.00
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,349.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,914.00
|
| Rate for Payer: Galaxy Health WC |
$4,067.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,871.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,038.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,823.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.40
|
| Rate for Payer: Multiplan Commercial |
$3,828.00
|
| Rate for Payer: Networks By Design Commercial |
$3,110.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,067.25
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$4,785.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$4,067.25 |
| Rate for Payer: Adventist Health Commercial |
$957.00
|
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,070.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,362.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,355.11
|
| Rate for Payer: Blue Shield of California Commercial |
$894.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,014.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,052.83
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: Cigna of CA HMO |
$1,359.36
|
| Rate for Payer: Cigna of CA HMO |
$3,062.40
|
| Rate for Payer: Cigna of CA PPO |
$1,571.76
|
| Rate for Payer: Cigna of CA PPO |
$3,540.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,486.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,349.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$4,067.25
|
| Rate for Payer: Galaxy Health WC |
$1,805.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,871.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,274.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,038.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,348.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,699.20
|
| Rate for Payer: Multiplan Commercial |
$3,828.00
|
| Rate for Payer: Networks By Design Commercial |
$3,110.25
|
| Rate for Payer: Networks By Design Commercial |
$1,380.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,805.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,067.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,871.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,871.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,392.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,392.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,062.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,392.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,062.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,392.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$6,674.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,334.80 |
| Max. Negotiated Rate |
$5,672.90 |
| Rate for Payer: Adventist Health Commercial |
$1,334.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,671.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,669.60
|
| Rate for Payer: Galaxy Health WC |
$5,672.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,237.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,937.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.76
|
| Rate for Payer: Multiplan Commercial |
$5,339.20
|
| Rate for Payer: Networks By Design Commercial |
$4,338.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,672.90
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$6,674.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,672.90 |
| Rate for Payer: Adventist Health Commercial |
$1,334.80
|
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,282.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,902.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,891.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,809.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,258.01
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cigna of CA HMO |
$1,896.96
|
| Rate for Payer: Cigna of CA HMO |
$4,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,193.36
|
| Rate for Payer: Cigna of CA PPO |
$4,938.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,074.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,671.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$5,672.90
|
| Rate for Payer: Galaxy Health WC |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,004.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$294.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$294.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,237.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,882.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,371.20
|
| Rate for Payer: Multiplan Commercial |
$5,339.20
|
| Rate for Payer: Networks By Design Commercial |
$4,338.10
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,672.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,004.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,004.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,337.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$5,982.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$5,084.70 |
| Rate for Payer: Adventist Health Commercial |
$1,196.40
|
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,838.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,704.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,118.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,694.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,518.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,816.52
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cigna of CA HMO |
$1,699.84
|
| Rate for Payer: Cigna of CA HMO |
$3,828.48
|
| Rate for Payer: Cigna of CA PPO |
$1,965.44
|
| Rate for Payer: Cigna of CA PPO |
$4,426.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,859.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,187.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$5,084.70
|
| Rate for Payer: Galaxy Health WC |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$255.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$255.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,798.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,686.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$289.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$289.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,124.80
|
| Rate for Payer: Multiplan Commercial |
$4,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,888.30
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,084.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,589.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,589.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,991.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
IP
|
$5,982.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,196.40 |
| Max. Negotiated Rate |
$5,084.70 |
| Rate for Payer: Adventist Health Commercial |
$1,196.40
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,187.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,392.80
|
| Rate for Payer: Galaxy Health WC |
$5,084.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,798.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,529.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.68
|
| Rate for Payer: Multiplan Commercial |
$4,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,888.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,084.70
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,401.20 |
| Max. Negotiated Rate |
$5,955.10 |
| Rate for Payer: Adventist Health Commercial |
$1,401.20
|
| Rate for Payer: Cash Price |
$3,152.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,904.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,802.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,802.40
|
| Rate for Payer: Galaxy Health WC |
$5,955.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,203.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,448.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,133.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.44
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: Networks By Design Commercial |
$4,553.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,955.10
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
OP
|
$7,006.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,955.10 |
| Rate for Payer: Adventist Health Commercial |
$1,401.20
|
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,495.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,095.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,949.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,469.83
|
| Rate for Payer: Cash Price |
$3,152.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$3,152.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$3,152.70
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA HMO |
$4,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Cigna of CA PPO |
$5,184.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,904.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$5,955.10
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,448.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,612.80
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: Networks By Design Commercial |
$4,553.90
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,955.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,203.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,203.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,503.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$5,710.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,853.50 |
| Rate for Payer: Adventist Health Commercial |
$1,142.00
|
| Rate for Payer: Cash Price |
$2,569.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.00
|
| Rate for Payer: Galaxy Health WC |
$4,853.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,625.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,368.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,370.40
|
| Rate for Payer: Multiplan Commercial |
$4,568.00
|
| Rate for Payer: Networks By Design Commercial |
$3,711.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,853.50
|
|
