|
HC CTLSO THORACI PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
905351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| 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 |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| 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: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.38
|
| 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 |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| 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 |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| 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: Health Management Network EPO/PPO |
$238.50
|
| 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 |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| 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 TRAPEZE SLING
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
915351070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.88
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| 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: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.45
|
| 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 |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| 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 |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| 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: Health Management Network EPO/PPO |
$252.00
|
| 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 |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| 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 |
905351070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.88
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| 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: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.45
|
| 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 |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| 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 |
915351070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| 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: Health Management Network EPO/PPO |
$252.00
|
| 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 |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| 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
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
915351120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.85 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.78
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| 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: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.85
|
| 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 |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| 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 |
915351120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| 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: Health Management Network EPO/PPO |
$168.30
|
| 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 |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| 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
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
905351120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| 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: Health Management Network EPO/PPO |
$168.30
|
| 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 |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| 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 |
$54.85 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.78
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| 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: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.85
|
| 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 |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,782.26 |
| Max. Negotiated Rate |
$5,192.10 |
| 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 |
$3,355.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| 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: Health Management Network EPO/PPO |
$5,192.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,782.26
|
| 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 |
$2,365.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Riverside University Health System MISP |
$2,307.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,165.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,107.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,061.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,889.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
915350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,782.26 |
| Max. Negotiated Rate |
$5,192.10 |
| 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 |
$3,355.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| 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: Health Management Network EPO/PPO |
$5,192.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,782.26
|
| 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 |
$2,365.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: Networks By Design Commercial |
$2,884.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Riverside University Health System MISP |
$2,307.60
|
| 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 |
$5,192.10 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| 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: Health Management Network EPO/PPO |
$5,192.10
|
| 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 |
$1,153.80
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| 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
|
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 |
$5,192.10 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| 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: Health Management Network EPO/PPO |
$5,192.10
|
| 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 |
$1,153.80
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| 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 CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$3,363.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$3,026.70 |
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,461.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,461.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,956.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,118.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,985.00
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,690.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,200.00
|
| Rate for Payer: Cigna of CA HMO |
$2,152.32
|
| Rate for Payer: Cigna of CA PPO |
$3,700.00
|
| Rate for Payer: Cigna of CA PPO |
$2,488.62
|
| 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 |
$3,500.00
|
| 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 |
$4,250.00
|
| Rate for Payer: Galaxy Health WC |
$2,858.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,017.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,026.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| 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 |
$308.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.81
|
| 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 |
$2,135.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| 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 |
$1,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Multiplan Commercial |
$2,522.25
|
| Rate for Payer: Networks By Design Commercial |
$2,185.95
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,858.55
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,017.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,017.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.50
|
| 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
|
$5,000.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
IP
|
$4,333.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$866.60 |
| Max. Negotiated Rate |
$3,899.70 |
| Rate for Payer: Adventist Health Commercial |
$866.60
|
| Rate for Payer: Cash Price |
$1,949.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,466.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,033.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,733.20
|
| Rate for Payer: Galaxy Health WC |
$3,683.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,599.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,899.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,751.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,556.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.60
|
| Rate for Payer: Multiplan Commercial |
$3,249.75
|
| Rate for Payer: Networks By Design Commercial |
$2,816.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,683.05
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Adventist Health Commercial |
$866.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,172.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,172.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,520.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,415.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,729.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,532.79
|
| Rate for Payer: Blue Shield of California EPN |
$965.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,720.20
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,949.85
|
| Rate for Payer: Cash Price |
$1,949.85
|
| Rate for Payer: Cash Price |
$1,949.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,946.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,466.40
|
| Rate for Payer: Cigna of CA HMO |
$2,773.12
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$3,206.42
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| 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 |
$3,033.10
|
| 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 |
$3,683.05
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,599.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,189.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,899.70
|
| 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 |
$252.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.24
|
| 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 |
$1,544.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,751.45
|
| 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 |
$866.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$3,249.75
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Networks By Design Commercial |
$2,816.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$3,683.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,599.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,599.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,166.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,166.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,166.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,166.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| 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 MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$978.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$978.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,200.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,235.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,383.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.12
|
| Rate for Payer: Blue Shield of California EPN |
$843.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,501.85
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Cigna of CA HMO |
$2,421.12
|
| Rate for Payer: Cigna of CA HMO |
$1,359.36
|
| Rate for Payer: Cigna of CA PPO |
$2,799.42
|
| Rate for Payer: Cigna of CA PPO |
$1,571.76
|
| 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 |
$2,648.10
|
| 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 |
$3,215.55
|
| Rate for Payer: Galaxy Health WC |
$1,805.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,274.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,911.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| 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 |
$212.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.16
|
| 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 |
$1,348.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| 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 |
$756.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.60
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,805.40
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,269.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,891.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,891.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,062.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,062.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,891.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.00
|
| 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 MAXILLOFAC W/O CO
|
Facility
|
IP
|
$3,783.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,648.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,231.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$5,277.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,055.40 |
| Max. Negotiated Rate |
$4,749.30 |
| Rate for Payer: Adventist Health Commercial |
$1,055.40
|
| Rate for Payer: Cash Price |
$2,374.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,221.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,693.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,110.80
|
| Rate for Payer: Galaxy Health WC |
$4,485.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,749.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,350.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,113.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.40
|
| Rate for Payer: Multiplan Commercial |
$3,957.75
|
| Rate for Payer: Networks By Design Commercial |
$3,430.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,485.45
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Adventist Health Commercial |
$1,055.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,172.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,172.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,069.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,724.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,324.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,867.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,176.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.97
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$2,374.65
|
| Rate for Payer: Cash Price |
$2,374.65
|
| Rate for Payer: Cash Price |
$2,374.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,371.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,221.60
|
| Rate for Payer: Cigna of CA HMO |
$3,377.28
|
| Rate for Payer: Cigna of CA HMO |
$1,896.96
|
| Rate for Payer: Cigna of CA PPO |
$3,904.98
|
| Rate for Payer: Cigna of CA PPO |
$2,193.36
|
| 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 |
$3,693.90
|
| 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 |
$4,485.45
|
| Rate for Payer: Galaxy Health WC |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,667.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,749.30
|
| 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 |
$301.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$301.71
|
| 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 |
$1,882.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,350.89
|
| 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 |
$1,055.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$3,957.75
|
| Rate for Payer: Multiplan Commercial |
$2,223.00
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: Networks By Design Commercial |
$3,430.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$4,485.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,166.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,778.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,638.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,638.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,638.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,638.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,482.00
|
| 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
|
IP
|
$4,730.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$946.00 |
| Max. Negotiated Rate |
$4,257.00 |
| Rate for Payer: Adventist Health Commercial |
$946.00
|
| Rate for Payer: Cash Price |
$2,128.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,784.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,311.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,892.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,892.00
|
| Rate for Payer: Galaxy Health WC |
$4,020.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,838.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,257.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,003.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,790.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.00
|
| Rate for Payer: Multiplan Commercial |
$3,547.50
|
| Rate for Payer: Networks By Design Commercial |
$3,074.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,020.50
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,390.40 |
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| Rate for Payer: Adventist Health Commercial |
$946.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$979.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$979.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,751.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,545.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,979.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,673.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,877.81
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$2,128.50
|
| Rate for Payer: Cash Price |
$2,128.50
|
| Rate for Payer: Cash Price |
$2,128.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,124.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,784.00
|
| Rate for Payer: Cigna of CA HMO |
$3,027.20
|
| Rate for Payer: Cigna of CA HMO |
$1,699.84
|
| Rate for Payer: Cigna of CA PPO |
$3,500.20
|
| Rate for Payer: Cigna of CA PPO |
$1,965.44
|
| 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 |
$3,311.00
|
| 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 |
$4,020.50
|
| Rate for Payer: Galaxy Health WC |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,838.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,390.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,257.00
|
| 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 |
$262.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$262.02
|
| 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 |
$1,686.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,003.55
|
| 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 |
$946.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$3,547.50
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: Networks By Design Commercial |
$3,074.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$4,020.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,838.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,838.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,593.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,365.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,328.00
|
| 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 W/WO CNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Adventist Health Commercial |
$1,107.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,222.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,899.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,489.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,057.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,198.98
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$2,492.55
|
| Rate for Payer: Cash Price |
$2,492.55
|
| Rate for Payer: Cash Price |
$2,492.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,431.20
|
| Rate for Payer: Cigna of CA HMO |
$3,544.96
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$4,098.86
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| 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 |
$3,877.30
|
| 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 |
$4,708.15
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,323.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,985.10
|
| 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 |
$354.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.80
|
| 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 |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,517.26
|
| 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 |
$1,107.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,154.25
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Networks By Design Commercial |
$3,600.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$4,708.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,323.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,323.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,769.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,769.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,769.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,769.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| 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
|
|
