|
HC CTLSO LUMBAR RIB PAD
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
905351040
|
|
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 |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| 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: 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 |
$94.34
|
| Rate for Payer: InnovAge PACE Commercial |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| 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 |
$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 LUMBAR SLING
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
915351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.13
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.26
|
| Rate for Payer: InnovAge PACE Commercial |
$152.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.13
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.26
|
| Rate for Payer: InnovAge PACE Commercial |
$152.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
915351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,344.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,832.48
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,496.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,058.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,141.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.00
|
| Rate for Payer: Multiplan Commercial |
$4,215.00
|
| Rate for Payer: Networks By Design Commercial |
$3,653.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,840.55 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,091.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,300.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,344.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,832.48
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,496.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,777.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,058.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,167.32
|
| Rate for Payer: InnovAge PACE Commercial |
$2,810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,934.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,934.00
|
| Rate for Payer: Multiplan Commercial |
$4,215.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.00
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
IP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
915351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,344.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,832.48
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,496.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,058.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,141.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.00
|
| Rate for Payer: Multiplan Commercial |
$4,215.00
|
| Rate for Payer: Networks By Design Commercial |
$3,653.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
|
|
HC CTLSO MILWAUKEE
|
Facility
|
OP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
915351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,840.55 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,091.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,300.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,344.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,832.48
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Cash Price |
$3,091.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,496.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.00
|
| Rate for Payer: Cigna of CA PPO |
$3,934.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,777.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,248.00
|
| Rate for Payer: Galaxy Health WC |
$4,777.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,058.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,167.32
|
| Rate for Payer: InnovAge PACE Commercial |
$2,810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,478.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,934.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,934.00
|
| Rate for Payer: Multiplan Commercial |
$4,215.00
|
| Rate for Payer: Networks By Design Commercial |
$2,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,777.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,052.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2,008.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,840.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,777.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.00
|
|
|
HC CTLSO MINERVA
|
Facility
|
OP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.64 |
| Max. Negotiated Rate |
$3,912.30 |
| Rate for Payer: Adventist Health Commercial |
$1,782.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,390.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,552.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.89
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,477.60
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,694.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,694.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,578.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2,173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,042.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,042.90
|
| Rate for Payer: Multiplan Commercial |
$3,260.25
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,738.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,694.95
|
|
|
HC CTLSO MINERVA
|
Facility
|
OP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
915350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.64 |
| Max. Negotiated Rate |
$3,912.30 |
| Rate for Payer: Adventist Health Commercial |
$1,782.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,390.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,552.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.89
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,477.60
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,694.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,694.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,578.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2,173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,042.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,042.90
|
| Rate for Payer: Multiplan Commercial |
$3,260.25
|
| Rate for Payer: Networks By Design Commercial |
$2,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,738.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,694.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,694.95
|
|
|
HC CTLSO MINERVA
|
Facility
|
IP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$3,912.30 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.89
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,477.60
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$3,260.25
|
| Rate for Payer: Networks By Design Commercial |
$2,825.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
|
|
HC CTLSO MINERVA
|
Facility
|
IP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
915350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$3,912.30 |
| Rate for Payer: Adventist Health Commercial |
$869.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,360.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.89
|
| Rate for Payer: Cash Price |
$2,390.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,477.60
|
| Rate for Payer: Cigna of CA HMO |
$3,042.90
|
| Rate for Payer: Cigna of CA PPO |
$3,042.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.80
|
| Rate for Payer: Galaxy Health WC |
$3,694.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,656.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,690.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$3,260.25
|
| Rate for Payer: Networks By Design Commercial |
$2,825.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,694.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,587.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.64
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
915351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: InnovAge PACE Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Riverside University Health System MISP |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: InnovAge PACE Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Riverside University Health System MISP |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC CTLSO OUTRIGGER
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
915351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
915351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$638.10 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Blue Shield of California Commercial |
$548.06
|
| Rate for Payer: Blue Shield of California EPN |
$357.34
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Central Health Plan Commercial |
$567.20
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$638.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.80
|
| Rate for Payer: Multiplan Commercial |
$531.75
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
905351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$638.10 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Blue Shield of California Commercial |
$548.06
|
| Rate for Payer: Blue Shield of California EPN |
$357.34
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Central Health Plan Commercial |
$567.20
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$638.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.80
|
| Rate for Payer: Multiplan Commercial |
$531.75
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
915351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$638.10 |
| Rate for Payer: Adventist Health Commercial |
$290.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$389.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$531.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.40
|
| Rate for Payer: Blue Shield of California Commercial |
$548.06
|
| Rate for Payer: Blue Shield of California EPN |
$357.34
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Central Health Plan Commercial |
$567.20
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$602.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$602.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$602.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$638.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.10
|
| Rate for Payer: InnovAge PACE Commercial |
$354.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.30
|
| Rate for Payer: Multiplan Commercial |
$531.75
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Riverside University Health System MISP |
$283.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.65
|
| Rate for Payer: Vantage Medical Group Senior |
$602.65
|
|
|
HC CTLSO RING FLANGE
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
905351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$638.10 |
| Rate for Payer: Adventist Health Commercial |
$290.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$389.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$531.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.40
|
| Rate for Payer: Blue Shield of California Commercial |
$548.06
|
| Rate for Payer: Blue Shield of California EPN |
$357.34
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Central Health Plan Commercial |
$567.20
|
| Rate for Payer: Cigna of CA HMO |
$496.30
|
| Rate for Payer: Cigna of CA PPO |
$496.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$602.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$602.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$602.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$638.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.10
|
| Rate for Payer: InnovAge PACE Commercial |
$354.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.30
|
| Rate for Payer: Multiplan Commercial |
$531.75
|
| Rate for Payer: Networks By Design Commercial |
$354.50
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Riverside University Health System MISP |
$283.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.09
|
| Rate for Payer: United Healthcare All Other HMO |
$259.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.65
|
| Rate for Payer: Vantage Medical Group Senior |
$602.65
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
915351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
905351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$215.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.92
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.27
|
| Rate for Payer: InnovAge PACE Commercial |
$263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$368.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$368.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Riverside University Health System MISP |
$210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
905351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
915351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$215.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.92
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.27
|
| Rate for Payer: InnovAge PACE Commercial |
$263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$368.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$368.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Riverside University Health System MISP |
$210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
