|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
915350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.16
|
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
915350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.16 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: Adventist Health Commercial |
$372.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.49
|
| Rate for Payer: Blue Shield of California Commercial |
$670.84
|
| Rate for Payer: Blue Shield of California EPN |
$441.77
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$610.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$636.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$636.30
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
905350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.16 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: Adventist Health Commercial |
$372.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.49
|
| Rate for Payer: Blue Shield of California Commercial |
$670.84
|
| Rate for Payer: Blue Shield of California EPN |
$441.77
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$610.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$636.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$636.30
|
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
OP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
915351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$974.88 |
| Max. Negotiated Rate |
$3,452.70 |
| Rate for Payer: Adventist Health Commercial |
$1,665.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,234.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,046.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,352.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,974.13
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cigna of CA HMO |
$2,843.40
|
| Rate for Payer: Cigna of CA PPO |
$2,843.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,452.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.80
|
| Rate for Payer: Galaxy Health WC |
$3,452.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,724.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,843.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,843.40
|
| Rate for Payer: Multiplan Commercial |
$3,249.60
|
| Rate for Payer: Networks By Design Commercial |
$2,031.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,437.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,437.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,524.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,452.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,452.70
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
IP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
905351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$812.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cigna of CA HMO |
$2,843.40
|
| Rate for Payer: Cigna of CA PPO |
$2,843.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.80
|
| Rate for Payer: Galaxy Health WC |
$3,452.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.88
|
| Rate for Payer: Multiplan Commercial |
$3,249.60
|
| Rate for Payer: Networks By Design Commercial |
$2,031.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,524.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.31
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
IP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
915351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$812.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cigna of CA HMO |
$2,843.40
|
| Rate for Payer: Cigna of CA PPO |
$2,843.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.80
|
| Rate for Payer: Galaxy Health WC |
$3,452.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.88
|
| Rate for Payer: Multiplan Commercial |
$3,249.60
|
| Rate for Payer: Networks By Design Commercial |
$2,031.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,524.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.31
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
OP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
905351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$974.88 |
| Max. Negotiated Rate |
$3,452.70 |
| Rate for Payer: Adventist Health Commercial |
$1,665.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,234.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,046.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,352.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,974.13
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cash Price |
$2,234.10
|
| Rate for Payer: Cigna of CA HMO |
$2,843.40
|
| Rate for Payer: Cigna of CA PPO |
$2,843.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,452.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.80
|
| Rate for Payer: Galaxy Health WC |
$3,452.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,724.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,843.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,843.40
|
| Rate for Payer: Multiplan Commercial |
$3,249.60
|
| Rate for Payer: Networks By Design Commercial |
$2,031.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,437.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,437.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,524.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,452.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,452.70
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
915351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$700.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,925.00
|
| Rate for Payer: Cash Price |
$1,925.00
|
| Rate for Payer: Cigna of CA HMO |
$2,450.00
|
| Rate for Payer: Cigna of CA PPO |
$2,450.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,400.00
|
| Rate for Payer: Galaxy Health WC |
$2,975.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,166.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$2,800.00
|
| Rate for Payer: Networks By Design Commercial |
$1,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,313.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,250.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,146.25
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
905351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$316.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$869.00
|
| Rate for Payer: Cash Price |
$869.00
|
| Rate for Payer: Cigna of CA HMO |
$1,106.00
|
| Rate for Payer: Cigna of CA PPO |
$1,106.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.00
|
| Rate for Payer: EPIC Health Plan Senior |
$632.00
|
| Rate for Payer: Galaxy Health WC |
$1,343.00
|
| Rate for Payer: Global Benefits Group Commercial |
$948.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$978.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.20
|
| Rate for Payer: Multiplan Commercial |
$1,264.00
|
| Rate for Payer: Networks By Design Commercial |
$790.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.97
|
| Rate for Payer: United Healthcare All Other HMO |
$577.17
|
| Rate for Payer: United Healthcare HMO Rider |
$564.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.45
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
915351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Adventist Health Commercial |
$1,435.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,975.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,925.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,027.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,583.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.00
|
| Rate for Payer: Cash Price |
$1,925.00
|
| Rate for Payer: Cash Price |
$1,925.00
|
| Rate for Payer: Cigna of CA HMO |
$2,450.00
|
| Rate for Payer: Cigna of CA PPO |
$2,450.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,975.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,975.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,975.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,400.00
|
| Rate for Payer: Galaxy Health WC |
$2,975.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,166.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,450.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,450.00
|
| Rate for Payer: Multiplan Commercial |
$2,800.00
|
| Rate for Payer: Networks By Design Commercial |
$1,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,100.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,313.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,250.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,146.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,975.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,975.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,975.00
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
905351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.20 |
| Max. Negotiated Rate |
$1,541.74 |
| Rate for Payer: Adventist Health Commercial |
$647.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$869.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,185.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.04
|
| Rate for Payer: Blue Shield of California EPN |
$767.88
|
| Rate for Payer: Cash Price |
$869.00
|
| Rate for Payer: Cash Price |
$869.00
|
| Rate for Payer: Cigna of CA HMO |
$1,106.00
|
| Rate for Payer: Cigna of CA PPO |
$1,106.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,343.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.00
|
| Rate for Payer: EPIC Health Plan Senior |
$632.00
|
| Rate for Payer: Galaxy Health WC |
$1,343.00
|
| Rate for Payer: Global Benefits Group Commercial |
$948.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$978.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,106.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,106.00
|
| Rate for Payer: Multiplan Commercial |
$1,264.00
|
| Rate for Payer: Networks By Design Commercial |
$790.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$948.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$948.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.97
|
| Rate for Payer: United Healthcare All Other HMO |
$577.17
|
| Rate for Payer: United Healthcare HMO Rider |
$564.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,343.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,343.00
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
915350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$750.24 |
| Max. Negotiated Rate |
$2,657.10 |
| Rate for Payer: Adventist Health Commercial |
$1,281.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,719.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,810.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,306.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,519.24
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,657.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,657.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,100.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,188.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$2,500.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,875.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,657.10
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$750.24 |
| Max. Negotiated Rate |
$2,657.10 |
| Rate for Payer: Adventist Health Commercial |
$1,281.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,719.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,810.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,306.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,519.24
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,657.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,657.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,100.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,188.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$2,500.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,875.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,657.10
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
915350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.24
|
| Rate for Payer: Multiplan Commercial |
$2,500.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.24
|
| Rate for Payer: Multiplan Commercial |
$2,500.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
915350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$487.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.64
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$584.64 |
| Max. Negotiated Rate |
$2,070.60 |
| Rate for Payer: Adventist Health Commercial |
$998.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,339.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,827.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,797.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.90
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,070.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,636.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,461.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,070.60
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
915350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$584.64 |
| Max. Negotiated Rate |
$2,070.60 |
| Rate for Payer: Adventist Health Commercial |
$998.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,339.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,827.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,797.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.90
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,070.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,636.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,461.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,070.60
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$487.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.64
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
915350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
915350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.90
|
| Rate for Payer: Blue Shield of California Commercial |
$642.06
|
| Rate for Payer: Blue Shield of California EPN |
$422.82
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$545.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.90
|
| Rate for Payer: Blue Shield of California Commercial |
$642.06
|
| Rate for Payer: Blue Shield of California EPN |
$422.82
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$545.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
915350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$725.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$725.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.24
|
| Rate for Payer: Multiplan Commercial |
$2,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
915350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.24 |
| Max. Negotiated Rate |
$3,082.10 |
| Rate for Payer: Adventist Health Commercial |
$1,486.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,719.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,100.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,675.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,762.24
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,082.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,274.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.20
|
| Rate for Payer: Multiplan Commercial |
$2,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,175.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,175.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.10
|
|
