|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$377.50
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Adventist Health Commercial |
$309.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.30
|
| Rate for Payer: Blue Shield of California Commercial |
$557.19
|
| Rate for Payer: Blue Shield of California EPN |
$366.93
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$641.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$641.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$641.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$528.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$528.50
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$377.50
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$641.75
|
| Rate for Payer: Vantage Medical Group Senior |
$641.75
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Adventist Health Commercial |
$271.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.43
|
| Rate for Payer: Blue Shield of California Commercial |
$488.56
|
| Rate for Payer: Blue Shield of California EPN |
$321.73
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$562.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$463.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$463.40
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
915350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.76 |
| Max. Negotiated Rate |
$296.65 |
| Rate for Payer: Adventist Health Commercial |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.14
|
| Rate for Payer: Blue Shield of California Commercial |
$257.56
|
| Rate for Payer: Blue Shield of California EPN |
$169.61
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
915350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.76 |
| Max. Negotiated Rate |
$296.65 |
| Rate for Payer: Adventist Health Commercial |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.14
|
| Rate for Payer: Blue Shield of California Commercial |
$257.56
|
| Rate for Payer: Blue Shield of California EPN |
$169.61
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$518.08
|
| Rate for Payer: Blue Shield of California EPN |
$341.17
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
915350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$518.08
|
| Rate for Payer: Blue Shield of California EPN |
$341.17
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
915350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.12
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$375.12 |
| Max. Negotiated Rate |
$1,328.55 |
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,153.49
|
| Rate for Payer: Blue Shield of California EPN |
$759.62
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.12
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$375.12 |
| Max. Negotiated Rate |
$1,328.55 |
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,153.49
|
| Rate for Payer: Blue Shield of California EPN |
$759.62
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
915350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.92 |
| Max. Negotiated Rate |
$283.05 |
| Rate for Payer: Adventist Health Commercial |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.87
|
| Rate for Payer: Blue Shield of California Commercial |
$245.75
|
| Rate for Payer: Blue Shield of California EPN |
$161.84
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.10
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
915350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.92 |
| Max. Negotiated Rate |
$283.05 |
| Rate for Payer: Adventist Health Commercial |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.87
|
| Rate for Payer: Blue Shield of California Commercial |
$245.75
|
| Rate for Payer: Blue Shield of California EPN |
$161.84
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.10
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
915351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,955.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
915351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.92 |
| Max. Negotiated Rate |
$4,363.05 |
| Rate for Payer: Adventist Health Commercial |
$2,104.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,973.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,788.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,494.64
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,079.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,351.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,593.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,593.10
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.05
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,955.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.92 |
| Max. Negotiated Rate |
$4,363.05 |
| Rate for Payer: Adventist Health Commercial |
$2,104.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,973.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,788.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,494.64
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,079.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,351.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,593.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,593.10
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.05
|
|
|
HC TLSO KNIGHT TAYLOR
|
Facility
|
IP
|
$790.00
|
|
| Hospital Charge Code |
905350330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna of CA HMO |
$553.00
|
| Rate for Payer: Cigna of CA PPO |
$553.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.00
|
| Rate for Payer: EPIC Health Plan Senior |
$316.00
|
| Rate for Payer: Galaxy Health WC |
$671.50
|
| Rate for Payer: Global Benefits Group Commercial |
$474.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$526.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$489.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.60
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: Networks By Design Commercial |
$395.00
|
| Rate for Payer: Prime Health Services Commercial |
$671.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.49
|
| Rate for Payer: United Healthcare All Other HMO |
$288.59
|
| Rate for Payer: United Healthcare HMO Rider |
$282.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.73
|
|
