|
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
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
905350486
|
|
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 ANT
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$555.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.72
|
| Rate for Payer: Multiplan Commercial |
$2,222.40
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$666.72 |
| Max. Negotiated Rate |
$2,361.30 |
| Rate for Payer: Adventist Health Commercial |
$1,138.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,527.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,083.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,609.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,050.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,350.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,361.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,361.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,866.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,110.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,944.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,944.60
|
| Rate for Payer: Multiplan Commercial |
$2,222.40
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,361.30
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
915350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$555.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.72
|
| Rate for Payer: Multiplan Commercial |
$2,222.40
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
915350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$666.72 |
| Max. Negotiated Rate |
$2,361.30 |
| Rate for Payer: Adventist Health Commercial |
$1,138.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,527.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,083.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,609.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,050.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,350.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,361.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,361.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,866.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,110.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,944.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,944.60
|
| Rate for Payer: Multiplan Commercial |
$2,222.40
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,361.30
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.04 |
| Max. Negotiated Rate |
$1,165.35 |
| Rate for Payer: Adventist Health Commercial |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$754.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,028.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$794.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,011.80
|
| Rate for Payer: Blue Shield of California EPN |
$666.31
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,165.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,165.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$860.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.70
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,165.35
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$274.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.04
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
915350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$274.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.04
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
915350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.04 |
| Max. Negotiated Rate |
$1,165.35 |
| Rate for Payer: Adventist Health Commercial |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$754.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,028.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$794.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,011.80
|
| Rate for Payer: Blue Shield of California EPN |
$666.31
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,165.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,165.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$860.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.70
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,165.35
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
915350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna of CA HMO |
$1,680.00
|
| Rate for Payer: Cigna of CA PPO |
$1,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$960.00
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,485.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$1,920.00
|
| Rate for Payer: Networks By Design Commercial |
$1,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.72
|
| Rate for Payer: United Healthcare All Other HMO |
$876.72
|
| Rate for Payer: United Healthcare HMO Rider |
$857.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
915350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Adventist Health Commercial |
$984.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,040.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,800.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,390.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,771.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna of CA HMO |
$1,680.00
|
| Rate for Payer: Cigna of CA PPO |
$1,680.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,040.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,040.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$960.00
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,318.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,491.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,485.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,680.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,680.00
|
| Rate for Payer: Multiplan Commercial |
$1,920.00
|
| Rate for Payer: Networks By Design Commercial |
$1,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,440.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,440.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.72
|
| Rate for Payer: United Healthcare All Other HMO |
$876.72
|
| Rate for Payer: United Healthcare HMO Rider |
$857.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,040.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,040.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,040.00
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$1,491.23 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.64
|
| Rate for Payer: Blue Shield of California Commercial |
$807.37
|
| Rate for Payer: Blue Shield of California EPN |
$531.68
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,318.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,491.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
915350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
915350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.48 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,876.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,449.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,846.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.97
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,569.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,751.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.48 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,876.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,449.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,846.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.97
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,569.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,751.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
915350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.60
|
| Rate for Payer: Multiplan Commercial |
$1,352.00
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
915350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$1,436.50 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.22
|
| Rate for Payer: Blue Shield of California EPN |
$821.34
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,060.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,352.00
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.60
|
| Rate for Payer: Multiplan Commercial |
$1,352.00
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$1,436.50 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.22
|
| Rate for Payer: Blue Shield of California EPN |
$821.34
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,060.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,352.00
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
915350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.64
|
| Rate for Payer: Blue Shield of California Commercial |
$807.37
|
| Rate for Payer: Blue Shield of California EPN |
$531.68
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.64
|
| Rate for Payer: Blue Shield of California Commercial |
$807.37
|
| Rate for Payer: Blue Shield of California EPN |
$531.68
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
