|
HC CTLSO LUMBAR RIB PAD
|
Facility
IP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
905351040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Blue Shield of California EPN |
$149.52
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$56.00
|
| 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
|
|
|
HC CTLSO LUMBAR SLING
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT L1090
|
| Hospital Charge Code |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$380.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$167.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.19
|
| Rate for Payer: BCBS Transplant Transplant |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.75
|
| Rate for Payer: Blue Shield of California EPN |
$165.92
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| 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: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$228.75
|
| Rate for Payer: IEHP medi-cal |
$106.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| 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 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 |
$152.50
|
| Rate for Payer: United Healthcare All Other HMO |
$152.50
|
| Rate for Payer: United Healthcare HMO Rider |
$152.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.50
|
| 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 |
905351090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Blue Shield of California EPN |
$162.87
|
| Rate for Payer: Cash Price |
$137.25
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$61.00
|
| 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
|
|
|
HC CTLSO MILWAUKEE
|
Facility
OP
|
$5,620.00
|
|
|
Service Code
|
CPT L1000
|
| Hospital Charge Code |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,967.00 |
| Max. Negotiated Rate |
$8,428.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,428.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,777.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,091.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,091.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,721.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,320.30
|
| Rate for Payer: BCBS Transplant Transplant |
$3,372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,215.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,057.28
|
| Rate for Payer: Cash Price |
$2,529.00
|
| Rate for Payer: Cash Price |
$2,529.00
|
| 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: EPIC Health Plan Commercial |
$2,248.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4,215.00
|
| Rate for Payer: IEHP medi-cal |
$1,967.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,748.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.20
|
| 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 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 |
$2,810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,810.00
|
| 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 |
905351000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,001.08
|
| Rate for Payer: Cash Price |
$2,529.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,124.00
|
| 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
|
|
|
HC CTLSO MINERVA
|
Facility
OP
|
$4,347.00
|
|
|
Service Code
|
CPT L0700
|
| Hospital Charge Code |
905350700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,521.45 |
| Max. Negotiated Rate |
$8,393.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,393.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,694.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,390.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,390.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,104.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,568.21
|
| Rate for Payer: BCBS Transplant Transplant |
$2,608.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,260.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.77
|
| Rate for Payer: Cash Price |
$1,956.15
|
| Rate for Payer: Cash Price |
$1,956.15
|
| 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: EPIC Health Plan Commercial |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,260.25
|
| Rate for Payer: IEHP medi-cal |
$1,521.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,899.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.27
|
| 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 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 |
$2,173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,173.50
|
| 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: Blue Shield of California EPN |
$2,321.30
|
| Rate for Payer: Cash Price |
$1,956.15
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$869.40
|
| 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
|
|
|
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: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$75.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$33.60
|
| 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
|
|
|
HC CTLSO OUTRIGGER
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
CPT L1080
|
| Hospital Charge Code |
905351080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$229.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$229.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$92.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.25
|
| Rate for Payer: BCBS Transplant Transplant |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$91.39
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| 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: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$126.00
|
| Rate for Payer: IEHP medi-cal |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| 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 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 |
$84.00
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC CTLSO RING FLANGE
|
Facility
OP
|
$709.00
|
|
|
Service Code
|
CPT L1100
|
| Hospital Charge Code |
905351100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.15 |
| Max. Negotiated Rate |
$660.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$660.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$602.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$389.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$389.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$343.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.88
|
| Rate for Payer: BCBS Transplant Transplant |
$425.40
|
| Rate for Payer: Blue Shield of California Commercial |
$531.75
|
| Rate for Payer: Blue Shield of California EPN |
$385.70
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| 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: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$531.75
|
| Rate for Payer: IEHP medi-cal |
$248.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.69
|
| 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 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 |
$354.50
|
| Rate for Payer: United Healthcare All Other HMO |
$354.50
|
| Rate for Payer: United Healthcare HMO Rider |
$354.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.65
|
| Rate for Payer: Vantage Medical Group Senior |
$602.65
|
|
|
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: Blue Shield of California EPN |
$378.61
|
| Rate for Payer: Cash Price |
$319.05
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$141.80
|
| 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
|
|
|
HC CTLSO RING FLANGE MOLDED
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT L1110
|
| Hospital Charge Code |
905351110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$1,060.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,060.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$289.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.76
|
| Rate for Payer: BCBS Transplant Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$394.50
|
| Rate for Payer: Blue Shield of California EPN |
$286.14
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| 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: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$394.50
|
| Rate for Payer: IEHP medi-cal |
$184.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.66
|
| 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 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 |
$263.00
|
| Rate for Payer: United Healthcare All Other HMO |
$263.00
|
| Rate for Payer: United Healthcare HMO Rider |
$263.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.00
|
| 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: Blue Shield of California EPN |
$280.88
|
| Rate for Payer: Cash Price |
$236.70
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$105.20
|
| 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
|
|
|
HC CTLSO STERNAL PAD
|
Facility
OP
|
$265.00
|
|
|
Service Code
|
CPT L1050
|
| Hospital Charge Code |
905351050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$345.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.56
|
| Rate for Payer: BCBS Transplant Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$144.16
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$198.75
|
| Rate for Payer: IEHP medi-cal |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| 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 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 |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
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: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$176.76
|
| 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 |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC CTLSO THORACI PAD
|
Facility
OP
|
$265.00
|
|
|
Service Code
|
CPT L1060
|
| Hospital Charge Code |
905351060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$397.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$397.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.56
|
| Rate for Payer: BCBS Transplant Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$144.16
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$198.75
|
| Rate for Payer: IEHP medi-cal |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| 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 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 |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| 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: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$176.76
|
| 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 |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
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: Blue Shield of California EPN |
$149.52
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$56.00
|
| 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
|
|
|
HC CTLSO TRAPEZE SLING
|
Facility
OP
|
$280.00
|
|
|
Service Code
|
CPT L1070
|
| Hospital Charge Code |
905351070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$373.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$373.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.42
|
| Rate for Payer: BCBS Transplant Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.00
|
| Rate for Payer: Blue Shield of California EPN |
$152.32
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$210.00
|
| Rate for Payer: IEHP medi-cal |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| 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 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 |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| 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
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: Blue Shield of California EPN |
$99.86
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$37.40
|
| 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
|
|
|
HC CTLSO UPRIGHT COVER EA
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT L1120
|
| Hospital Charge Code |
905351120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$164.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.48
|
| Rate for Payer: BCBS Transplant Transplant |
$112.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.25
|
| Rate for Payer: Blue Shield of California EPN |
$101.73
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$140.25
|
| Rate for Payer: IEHP medi-cal |
$65.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| 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 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 |
$93.50
|
| Rate for Payer: United Healthcare All Other HMO |
$93.50
|
| Rate for Payer: United Healthcare HMO Rider |
$93.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
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: Blue Shield of California EPN |
$3,080.65
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$1,153.80
|
| 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
|
|
|
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 |
$2,019.15 |
| Max. Negotiated Rate |
$8,670.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,670.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,172.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,793.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,408.33
|
| Rate for Payer: BCBS Transplant Transplant |
$3,461.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,326.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,138.34
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,615.20
|
| Rate for Payer: Cigna of CA HMO |
$4,038.30
|
| Rate for Payer: Cigna of CA PPO |
$4,038.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,903.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4,326.75
|
| Rate for Payer: IEHP medi-cal |
$2,019.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.29
|
| 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 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 |
$2,884.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,884.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,884.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,884.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,560.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,461.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,337.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,444.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,922.62
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,164.80
|
| Rate for Payer: Cigna of CA HMO |
$2,531.84
|
| Rate for Payer: Cigna of CA PPO |
$2,927.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,560.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,967.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,967.00
|
| Rate for Payer: Networks By Design Commercial |
$2,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,362.60
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,978.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,978.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,978.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
IP
|
$5,882.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,176.40 |
| Max. Negotiated Rate |
$5,293.80 |
| Rate for Payer: Cash Price |
$2,646.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,705.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,352.80
|
| Rate for Payer: Galaxy Health WC |
$4,999.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,293.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.40
|
| Rate for Payer: Multiplan Commercial |
$4,411.50
|
| Rate for Payer: Networks By Design Commercial |
$3,823.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,999.70
|
|
