|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
915350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Adventist Health Commercial |
$341.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.21
|
| Rate for Payer: Blue Shield of California Commercial |
$640.58
|
| Rate for Payer: Blue Shield of California Commercial |
$422.33
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.19
|
| Rate for Payer: Blue Shield of California Commercial |
$94.81
|
| Rate for Payer: Blue Shield of California Commercial |
$143.80
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.19
|
| Rate for Payer: Blue Shield of California Commercial |
$94.81
|
| Rate for Payer: Blue Shield of California Commercial |
$143.80
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.98
|
| Rate for Payer: Blue Shield of California Commercial |
$83.82
|
| Rate for Payer: Blue Shield of California Commercial |
$55.26
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
915351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.98
|
| Rate for Payer: Blue Shield of California Commercial |
$83.82
|
| Rate for Payer: Blue Shield of California Commercial |
$55.26
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
915351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
915351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
915351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.98
|
| Rate for Payer: Blue Shield of California Commercial |
$74.53
|
| Rate for Payer: Blue Shield of California Commercial |
$113.04
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.98
|
| Rate for Payer: Blue Shield of California Commercial |
$74.53
|
| Rate for Payer: Blue Shield of California Commercial |
$113.04
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$401.20 |
| Rate for Payer: Adventist Health Commercial |
$193.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.70
|
| Rate for Payer: Blue Shield of California Commercial |
$362.97
|
| Rate for Payer: Blue Shield of California Commercial |
$239.30
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Networks By Design Commercial |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
915351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$401.20 |
| Rate for Payer: Adventist Health Commercial |
$193.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.70
|
| Rate for Payer: Blue Shield of California Commercial |
$362.97
|
| Rate for Payer: Blue Shield of California Commercial |
$239.30
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Networks By Design Commercial |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.28
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
915351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.28
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.96
|
| Rate for Payer: Blue Shield of California Commercial |
$313.75
|
| Rate for Payer: Blue Shield of California Commercial |
$206.86
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
915350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.96
|
| Rate for Payer: Blue Shield of California Commercial |
$313.75
|
| Rate for Payer: Blue Shield of California Commercial |
$206.86
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
915350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$463.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$420.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$390.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: Adventist Health Commercial |
$309.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$382.79
|
| Rate for Payer: Blue Shield of California Commercial |
$580.60
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$641.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$641.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$641.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$528.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$528.50
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$377.50
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$641.75
|
| Rate for Payer: Vantage Medical Group Senior |
$641.75
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$479.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Adventist Health Commercial |
$271.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.71
|
| Rate for Payer: Blue Shield of California Commercial |
$335.63
|
| Rate for Payer: Blue Shield of California Commercial |
$509.08
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$562.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$562.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$463.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$420.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$390.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$463.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$463.40
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
