|
HC CTLSO STERNAL PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 STERNAL PAD
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
915351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 STERNAL PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
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 |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 |
$99.79
|
| Rate for Payer: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$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 STERNAL PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
915351050
|
|
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 |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 |
$99.79
|
| Rate for Payer: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$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 |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 THORACI PAD
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
915351060
|
|
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 |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$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 |
905351060
|
|
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 |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| 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: 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: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$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 |
$92.45
|
| 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 |
$102.12
|
| 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 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 |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$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 |
$92.45
|
| 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 |
$102.12
|
| 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 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 |
$109.83
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cash Price |
$102.85
|
| 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: 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: InnovAge PACE Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$109.83
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cash Price |
$102.85
|
| 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: 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: InnovAge PACE Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$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 |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$3,388.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,459.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$3,172.95
|
| Rate for Payer: Cash Price |
$3,172.95
|
| 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: 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: InnovAge PACE Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,038.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| 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 |
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 |
$3,388.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,459.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$3,172.95
|
| Rate for Payer: Cash Price |
$3,172.95
|
| 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: 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: InnovAge PACE Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,968.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,038.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| 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 |
$4,459.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$3,172.95
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.80
|
| 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 |
$4,459.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,907.58
|
| Rate for Payer: Cash Price |
$3,172.95
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,571.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.80
|
| 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 |
$226.19 |
| Max. Negotiated Rate |
$3,026.70 |
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,461.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,975.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,041.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.11
|
| Rate for Payer: Cash Price |
$1,849.65
|
| Rate for Payer: Cash Price |
$1,849.65
|
| Rate for Payer: Cash Price |
$1,849.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,690.40
|
| Rate for Payer: Cigna of CA HMO |
$2,152.32
|
| Rate for Payer: Cigna of CA PPO |
$2,488.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,858.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,017.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,026.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,243.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,522.25
|
| Rate for Payer: Networks By Design Commercial |
$2,185.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,858.55
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,017.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,017.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
IP
|
$3,363.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$672.60 |
| Max. Negotiated Rate |
$3,026.70 |
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Cash Price |
$1,849.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,690.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,345.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,345.20
|
| Rate for Payer: Galaxy Health WC |
$2,858.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,017.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,026.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,243.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,281.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,081.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.60
|
| Rate for Payer: Multiplan Commercial |
$2,522.25
|
| Rate for Payer: Networks By Design Commercial |
$2,185.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,858.55
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,172.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,428.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.90
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,946.40
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,189.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$486.60 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.20
|
| Rate for Payer: EPIC Health Plan Senior |
$973.20
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,189.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,506.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.60
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
|
|
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 |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$978.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,289.27
|
| Rate for Payer: Blue Shield of California EPN |
$843.23
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Cigna of CA HMO |
$1,359.36
|
| Rate for Payer: Cigna of CA PPO |
$1,571.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,805.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,274.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,416.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,805.40
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.00
|
| 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 Select/Navigate/Core |
$1,062.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
